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The Effectiveness of Oral Metformin or Yoga Therapy as a Primary Treatment for Patient
with Type Two Diabetics’ Mellitus

Research proposal

B. L. M. B. Gunaratne, (209462247/1)

ICBT Campus, Galle, University of Sunderland, 2021 June Intake

NUR 319: Evidenced Based Practice

23th January 2022

Word count: 1042

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I declare that this is my own work and it has not been submitted for
another assignment.

Signature: B. L. M. B. Gunaratne.

Date: 18. 01. 2022

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The effectiveness of oral metformin or yoga therapy as a primary treatment for patient
with type two diabetics’ mellitus

Introduction

There are several treatments for glycemic control. Among them, yoga therapy and oral

metformin are the most widely used as primary treatments. When considering yoga, it is a

therapeutic system that improves mental and physical health by linking body, mind, and soul.

For this yoga postures, breathing, exercise, and meditation technique are used (Stephens, 2017).

Metformin is a drug used to lower blood sugar and increase insulin sensitivity. Long-term use of

metformin can cause side effects such as anemia and hypoglycemic (Bailey and Turner, 1996).

Although a patient with type two diabetes uses both of these treatments as a primary treatment,

the purpose of this study is to determine the correct treatment because they do not know exactly

what the best treatment is.

Yoga originated in India 5000 years ago (Raveendran, Deshpandae, and Joshi, 2018). Cui,

et. al. (2017) highlighted that in 1951, it was discovered that yoga was beneficial for improving

dietary and pharmacological activity. Also metformin was first used by Dr. Jean Sterne in 1957

for type two diabetics (Bailey 2017). However, the use of metformin was discontinued in the late

1970s due to the high risk of lactic acidosis. . Subsequently, metformin gained the trust of the

European community as an optimal drug for diabetes on the sensitivity to insulin, weight gain,

and blood sugar control without hypoglycemic risk. Metformin was introduced to the United

States in 1995 after intensive scrutiny. In1998 UK prospective diabetes study (UKPDS)

recommended metformin for glycemic control of type two diabetic. Considering the therapeutic

application of metformin it has now become the most widely recommended glucose-lowering

drugs world wild. (Rojas, and Gomes, 2013). Yoga exercise also reduces stress and increases
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physical activity. Therefore, it optimally enhances the body’s response to insulin. Hence people

all over the world are more inclined to use Yoga to control diabetes.

There were 465 million reported cases of diabetes in last year however it is projected to

grow to 578 million by 2030 (Standl, Khunti, Hansen, and Schnell, 2019). Diabetes patient in

urban areas is 10.8% higher than in rural areas. The prevalence of diabetes is higher in high-

income countries than in low-income countries As well as diabetes patients suffer from serious

complications and psychosocial problems (Westaway, Seager, Rheeder, and Van Zyl, 2005).

Early treatment is very much important to minimize this problem. Therefore the studies focus to

identify whether metformin or yoga can be used as a primary treatment for diabetes. The study’s

findings help identify the best primary treatment for controlling the severity of diabetes. It will

also give patients a better quality of life. Furthermore, health professionals will be able to

analyze the finding of the study and find the best option.

Research question

What is the effectiveness of oral metformin or yoga therapy as a primary treatment for patients

with type two diabetics’ mellitus?

Main objective

To explore the effectiveness of oral metformin or yoga therapy as a primary treatment for

patients with type two diabetes mellitus.

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Specific Objectives

I. To identify the effectiveness of oral metformin as a primary treatment for patients

with diabetics mellitus.

II. To identify the effectiveness of Yoga as a primary treatment for patients with diabetes

mellitus.

III. To compare the effectiveness of oral metformin versus yoga therapy as a primary

treatment for patients with type two diabetes mellitus.

Methodology

Methodology sets the philosophical framework on which research can be put into

practice. This includes systematic discoveries of things that people do not know (Brown 2006).

This study methodology is a systematic review. The purpose of this study is to review the

literature on the quality of treatment for diabetes

Study design

This study design is a systematic review. Denyer, and Tranfield, (2009) highlighted that a

systematic review is a review of a scientifically formulated question that analyzes the entire

research article related to the research question which is related to the effectiveness of oral

metformin or yoga therapy as a primary treatment for patients with type two diabetics mellitus.

There are some advantages and disadvantages to a systematic review (Kitchenham, 2004).

Stewart, and Tierney, (2002)stated that these study advantages are, all relevant research will

be investigated, the ability to get a quick answer from all the studies related to metformin and

yoga, a systematic review is more accurate and useful than individual studies, and evidence-
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based information can be applied to professional life. Furthermore, they stated that disadvantages

of the systematic review are, taking the time to conduct and publish a systematic review,

inability to analyze the literature due to lack of adequate research, and a systematic review can

quickly become outdated.

Systematic review process

A systematic review has five steps (Keller, 1987). Those are Identification of research,

Selection of the primary study, Study quality assessment, Data extract and monitoring, and Data

synthesis.

 Identification of research

Population Intervention Comparison Outcome

Patient with Diabetes Treatment for Oral metformin Prevention

Mellitus Diabetes Mellitus treatment compare complication

with yoga therapy

The most important step is to build the research question. PICO was used for this and the

question of what is the best treatment from metformin and yoga was formulated as follows.

PICO is represented P- population, I – intervention, C- comparison, O – outcome.

 Selection of the primary study.

Relevant literature for this study was obtained from Google Scholar, Science

Direct, PubMed, CINAHL sources. The keywords, metformin, Yoga, primary treatment,

Diabetes will be used to search relevant literature. Further, the most relevant and
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important articles will be selected using the inclusion and exclusion criteria through the

PRISMA flow chart.

 Study quality assessment

Selected articles will be critically appraisal for identifying the quality of study by using

the CASP tool. Falcon et. al. (2006) pointed out CASP tool is a method used to assess the quality

of the study.

 Data extract and monitoring

All the evidence in the articles will be collected. Based on that evidence, the key point of

the study will be captured to the specified standards. It provides a basis for assessing the

bias of studies and synthesizing findings (Aromataris, and Pearson, 2014).

 Data synthesis

The data obtained from the research articles related to the systematic review problem will

be analyzed jointly.
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References

Aromataris, E. and Pearson, A., 2014. The systematic review: an overview. AJN The American

Journal of Nursing, 114(3), pp.53-58.

Bailey, C.J. and Turner, R.C., 1996. Metformin. New England Journal of Medicine, 334(9),

pp.574-579.

Bailey, C.J., 2017. Metformin: historical overview. Diabetologia, 60(9), pp.1566-1576.

Brown RB, 2006, Doing Your Dissertation in Business and Management: The Reality of

Research and Writing, Sage Publications

Cui, J., Yan, J.H., Yan, L.M., Pan, L., Le, J.J. and Guo, Y.Z., 2017. Effects of yoga in adults

with type 2 diabetes mellitus: A meta‐analysis. Journal of Diabetes Investigation, 8(2), pp.201-

209.

Denyer, D. and Tranfield, D., 2009. Producing a Systematic Review.

Falcon, H., Crosse, A., Donaghy, J., Harrison, V., Hillman, L., Lawrence, A., Smith, M. and

White, S., 2006. CASP and CONSORT. British Dental Journal, 201(3), pp.130-131.

Keller, J.M., 1987. The Systematic Process of Motivational Design. Perform. Instr, 26, pp.1-8.

Kitchenham, B., 2004. Procedures for Performing Systematic Reviews. Keele, UK, Keele

University, 33(2004), pp.1-26.

Raveendran, A.V., Deshpandae, A. and Joshi, S.R., 2018. Therapeutic role of yoga in type 2

diabetes. Endocrinology and Metabolism, 33(3), pp.307-317.

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Rojas, L.B.A. and Gomes, M.B., 2013. Metformin: an old but still the best treatment for type 2

diabetes. Diabetology & Metabolic Syndrome, 5(1), pp.1-15.

Stephens, I., 2017. Medical yoga therapy. Children, 4(2), p.12.

Standl, E., Khunti, K., Hansen, T.B. and Schnell, O., 2019. The global epidemics of diabetes in

the 21st century: Current situation and perspectives. European Journal of Preventive Cardiology,

26(2_suppl), pp.7-14.

Stewart, L.A. and Tierney, J.F., 2002. To IPD or not to IPD? Advantages and disadvantages of

systematic reviews using individual patient data. Evaluation & the health professions, 25(1),

pp.76-97.

Westaway, M.S., Seager, J.R., Rheeder, P. and Van Zyl, D.G., 2005. The effects of social

support on health, well-being and management of diabetes mellitus: a black South African

perspective. Ethnicity & Health, 10(1), pp.73-89.