Immediate Effect of Mud Pack and Wet Pack to the Abdomen on Blood Glucose Levels and Cardiovascular Function in Patients with Type 2 Diabetes Mellitus: A Randomized Crossover Study

Abstract

Background:

Diabetes mellitus is a chronic condition marked by hyperglycemia due to impaired insulin secretion or resistance. Conventional managements often have side effects, leading to interest in nondrug interventions. This study examines the immediate effect of mud pack and wet pack on blood glucose levels and cardiovascular function in patients with type 2 diabetes mellitus (T2DM).

Materials and methods:

This randomized crossover study was conducted in 50 participants with T2DM. All participants were randomly assigned to two groups. Group 1 received a mud pack on day 1 and a wet pack on day 2, while group 2 received the interventions in reverse order. Blood glucose, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured before and immediately after the intervention.

Results:

Both mud pack and wet pack to the abdomen showed a significant reduction in random blood glucose levels after the intervention. In addition, the mud pack to the abdomen showed a significant reduction in SBP and DBP, whereas the wet pack did not show such significant changes in blood pressure.

Conclusions:

Both mud pack and wet pack to the abdomen were effective in lowering blood glucose levels. However, the mud pack was effective in reducing blood pressure, unlike the wet pack to the abdomen, in patients with T2DM.

Background

Diabetes mellitus is a chronic metabolic condition marked by sustained hyperglycemia, resulting from impaired insulin secretion, resistance to insulin’s peripheral effects, or a combination of both. ¹ In 2021, the global prevalence of diabetes among individuals aged 20–79 was estimated at 10.5%, affecting approximately 536.6 million people. This is expected to rise to 12.2% (783.2 million) by 2045. ² According to estimates from the International Diabetes Federation, 77 million people in India were living with diabetes in 2019, with this number expected to increase to 134 million by 2045. ³ Chronic hyperglycemia, in conjunction with other metabolic abnormalities in diabetes mellitus, can lead to widespread organ damage, resulting in severe and potentially life-threatening complications. The most notable of these include microvascular complications, such as retinopathy, nephropathy, and neuropathy, as well as macrovascular complications, which significantly increase the risk of cardiovascular diseases by two to four times. ⁴ The main therapeutic strategies for managing type 2 diabetes mellitus (T2DM) involve the use of insulin analogs and oral hypoglycemic agents. Although these interventions are critical for glucose control, they are frequently accompanied by adverse effects. ⁵

The World Health Organization (WHO) emphasizes the crucial contribution of traditional (naturopathic) medicine to health care. It maintains its acknowledgment as a culturally acceptable, cost-effective, and environmentally sustainable form of medicine. ⁶ Naturopathy is a distinct system of traditional and complementary medicine recognized by the WHO. Naturopathic clinical education emphasizes nondrug-based treatments including lifestyle-oriented self-care; preventive behaviors, dietary nutrition, physical activity, and stress-management counseling; clinical nutrition, herbal medicine, mud therapy, hydrotherapy, and hands-on manual therapies. ⁷ Mud therapy stands out as a readily available, affordable, and effective treatment method frequently employed in naturopathy for the management and prevention of numerous chronic ailments. ⁸ A mud pack involves the therapeutic use of natural substances comprising a blend of mineral-rich water (such as seawater or saltwater from lakes) combined with organic or inorganic compounds derived from geological, biological, or sometimes both processes. ⁹ Incorporating low-temperature mud therapy as a significant element in the treatment regimen for hypertensive and coronary heart disease patients is crucial, given its highly beneficial impact on general and intracardiac hemodynamics. ¹⁰ Hydrotherapy involves using water in various forms and temperatures to achieve different effects on the body’s systems. ¹¹ The cold abdominal pack (CAP) is a hydrotherapy technique used to treat various ailments. A previous study suggests that 20 min of CAP might improve the blood glucose levels and cardiovascular functions of patients with T2DM. ¹² This study aimed to assess the effect of mud pack and wet pack on the abdomen on blood glucose levels and cardiovascular function in patients with T2DM.

Materials and Methods

Study design and settings

A randomized crossover study was conducted at the Government Yoga and Naturopathy Medical College and Hospital, Chennai, India. All the participants were recruited and randomly divided into group 1 (G-1) and group 2 (G-2). G-1 received one session of mud pack and wet pack on days 1 and 2, respectively, while G-2 received the opposite. Assessments were done before and after the intervention (Figure 1).

FIG. 1.

Trail profile.

Subjects

Fifty T2DM participants of the Government Yoga and Naturopathy Medical College and Hospital, using a convenient sampling method. Inclusion criteria: Both genders aged between 18 and 70 years, diagnosed with T2DM, and were with or without oral conventional medication for diabetes. Exclusion criteria: Subjects with a history of T2DM complications, insulin therapy, cold sensitivity, allergic reaction to mud, skin allergy, open wounds in the abdomen, mental illnesses, and pregnant and menstruating women were excluded. Institutional Ethics Committee clearance was obtained from the Government Yoga and Naturopathy Medical College and Hospital before the recruitment of the first subject. The study protocol was explained to the subjects, and a signed consent was obtained from each participant.

Intervention

G-1 received only one session of mud pack on day 1 and wet pack on day 2 for 20 min, while G-2 received only one session of wet pack on day 1 and mud pack on day 2, respectively, for 20 min. Mud pack: The mud pack of 22.86 × 15.24 × 1.27 cm was placed over the abdomen in contact with the skin surface for 20 min [8]. Wet pack: The cotton cloth was dipped in cold water (15°C), wrung out, and then wrapped around the abdomen for 20 min.

Assessments

Random blood glucose.

Random blood sugar (RBS) levels of the subjects were assessed using a digital glucometer (Accu-Check).

Blood pressure.

Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were assessed using a digital sphygmomanometer (Omron HEM).

Sample size

Fifty T2DM participants were recruited for the study. The sample size was not calculated based on any previous studies, which is one of the limitations of this study.

Randomization and blinding

Participants were randomly divided (1:1 ratio) into two groups using simple random methods with the use of computerized randomization. Allocation concealment was done using sequentially numbered opaque, sealed envelopes. Participants and investigators were not blinded in this study.

Data analysis

The Kolmogorov–Smirnov test was used to check normality. Data were analyzed using a paired samples t-test or Wilcoxon signed rank test based on the data distribution using Statistical Package for the Social Sciences (SPSS), version 16. The effect size was calculated using G*Power 3.1.9.4.

Results

Fifty-six participants were approached for the study, and screened for eligibility, and six did not meet the eligibility criteria. A total of 50 participants met the eligibility criteria, and they were randomly allocated into G-1 (n = 25) and G-2 (n = 25). There were no dropouts in both groups, and thus, statistical analysis was done for all 50 participants. Demographic details are shown in Table 1.

Table 1.

Demographic Details of the Study Participants

Variable	Study participants (n = 50)
Age (years)	54.96 ± 8.9
Gender	Female (n = 27), male (n = 23)
Height (meters)	1.61 ± 0.09
Weight (kg)	69.36 ± 10.34

All values are in mean ± standard deviation, except gender.

The result of this study (between-group analysis) showed an insignificant decrease in parameters such as RBS, SBP, and DBP after the mudpack session compared with the wet pack session (Table 2). Within the mudpack session, analysis showed a significant decrease in RBS, SBP, and DBP in the post-test assessment compared with the pretest assessment. Whereas, within the wet pack session, analysis showed a significant reduction only in RBS, and no significant changes in SBP and DBP in the post-test assessment compared with the pretest assessment (Table 2). During and after the intervention, none of the participants were notified of any adverse effects.

Table 2.

Baseline and Post-Test Assessments of the Mudpack and Wet Pack Sessions

Parameter	Mud pack session analysis (n = 50)			Wet pack session analysis (n = 50)			P value (between sessions analysis)
	Baseline	Post-test	Effect size(d)	Baseline	Post-test	Effect size (d)
SBP (mmHg)	133.44 ± 14.10	129.78 ± 13.32	0.267	131.06 ± 13.56	129.38 ± 15.64	0.114	0.805
	z = 3.487	P < 0.001 *		z = 1.535	P = 0.125
DBP (mmHg)	87.16 ± 14.38	82.5 ± 6.57	0.374	84.42 ± 7.86	82.9 ± 9.25	0.176	0.530
	z = 2.893	P = 0.004 *		z = 1.730	P = 0.084
RBS (mg/dL)	224.04 ± 59.15	206.98 ± 55.44	0.297	211.12 ± 52.05	204.82 ± 49.48	0.124	0.728
	t = 3.104	P = 0.003 *		z = 3.022	P = 0.003 *

All the values are shown as mean ± standard deviation. t = paired-samples t-test; z = Wilcoxon signed rank test.

*

P value <0.05 from within-session analysis.

SBP, systolic blood pressure; DBP, diastolic blood pressure; RBS, random blood sugar.

Discussion

This randomized crossover trial aimed to assess the effect of mud pack and wet pack to the abdomen on blood glucose levels and cardiovascular function in patients with T2DM. The results of the present study showed a significant decrease in RBS, SBP, and DBP after the mud pack session and a significant reduction in RBS alone after the wet pack session. It suggests that the 20-min wet pack was effective in reducing RBS, while the mud pack was effective not only in reducing RBS but also was effective in reducing BP in patients with T2DM.

The potential mechanisms for the results of the study are as follows: Exposing a small surface area to cold, as in a CAP, leads to transient afferent discharges from cold fibers, eliciting cold sensations and heat-gain responses as skin temperature decreases. Hypothalamic signals prompt the constriction of peripheral blood vessels, which in turn triggers compensatory vasodilation in deeper vascular systems. This increases blood flow and metabolic rate in tissues beneath the exposure site, helping to maintain stable deep tissue temperature and potentially enhancing blood glucose utilization. ¹² Cold exposure activates the TRPM8 ion channel, promoting the conversion of white to brown adipose tissue, potentially enhancing energy expenditure, and aiding in diabetes treatment by improving brown tissue activity and density. This exposure increases metabolic heat production through shivering and nonshivering thermogenesis, primarily fueled by brown adipose tissue, to preserve core temperature. In addition, cold applications can lower blood sugar by boosting energy use and nonshivering thermogenesis via TRPM8 activation.^13,14

A cold mud pack causes immediate vasoconstriction, increasing central vascular pressure and stimulating the baroreceptors in the aortic and carotid regions. This activation excites the nucleus of the solitary tract, which in turn stimulates the vagal nucleus, leading to a reduction in sympathetic nerve activity. The decrease in sympathetic tone results in vasodilation, thereby lowering the heart rate (HR). ¹⁵ The decrease in BP may be due to a significant reduction in HR. BP is the result of cardiac output (CO) and peripheral resistance, and because CO depends on both HR and stroke volume, HR is a key factor in determining BP. ¹⁶

Previous studies have shown that 20 min of mud pack and cold pack to the abdomen were effective in the reduction of blood glucose levels and blood pressure in patients with T2DM and hypertensive individuals.^15,17 This supports our results and suggests that 20 min of mud pack and wet pack to the abdomen effectively reduce blood glucose levels and blood pressure.

Strength of this study

To our knowledge, this is the first-ever study to show the immediate effect of mud pack and wet pack to the abdomen on blood glucose levels and cardiovascular function in patients with T2DM. None of the subjects reported any side effects during and after the intervention.

Limitations of the study

This study shows only the immediate effect of mud pack and wet pack to the abdomen on blood glucose levels and cardiovascular function. Participants and investigators were not blinded to the intervention. Variables like respiratory rate, HR variability, and body temperature have not been used in our study. The study did not assess the long-term effect of the intervention and its underlying mechanism.

Future directions of the study

This research warrants replication with a larger sample size. T2DM patients associated with other co-morbidities such as obesity, hypertension, dyslipidemia, cardiovascular diseases, etc., can also be considered as study participants. In addition, it is essential to apply the therapy consistently over time to assess its long-term impact on various medical conditions.

Conclusions

Twenty minutes of both mud pack and wet pack to the abdomen were effective in lowering blood glucose levels. However, mud pack was effective in reducing BP, unlike wet pack to the abdomen, in patients with T2DM.