Abstract
Introduction:
Type 1 diabetes mellitus (T1DM), also known as insulin-dependent diabetes or juvenile diabetes, is a chronic illness in which the pancreas produces little or no insulin. The treatment emphasizes controlling blood sugar levels with insulin, food, and lifestyle changes to avoid complications. Reflexology is one of the complementary and alternative therapies used to treat various ailments. Reflexology on the pancreatic area of the palms (R-PAP) reduces blood glucose levels in type 2 diabetes. However, no study reported its effect in T1DM. This study aims to evaluate the effects of R-PAP on random blood glucose (RBG) levels in children with T1DM.
Method:
In this single-group pre-test and post-test experimental study, 50 children with T1DM were included. All the subjects underwent one session of R-PAP in the pancreatic area of both palms for 10 min. RBG levels were obtained before and immediately after R-PAP. Statistical analysis was done using the Statistical Package for the Social Sciences, version 16. A P value of <0.05 was considered significant.
Results:
There was a statistically significant reduction in RBG levels (from 314.92 ± 113.42 to 302.02 ± 112.94; P = 0.004) after the intervention compared to baseline assessment. None of the subjects reported any adverse effects during the study period.
Conclusions:
Ten minutes of R-PAP might have some effect in reducing blood glucose levels in children with T1DM. Small sample size, short intervention duration, no follow-up, minimum effect size, and a lack of a control group and other biomarkers are limiting the scope of this study. Hence, the results of this study should be treated cautiously, and further studies are recommended to validate the study results.
Introduction
Diabetes mellitus is a group of metabolic disorders with hyperglycemia due to a defect in insulin production, action, or both. 1 Type 1 diabetes mellitus (T1DM) is characterized by the autoimmune destruction of the insulin-producing pancreatic beta cell, which progresses to insulin insufficiency and subsequent hyperglycemia. 2 The incidence and prevalence of T1DM are rising globally, with annual increases in the incidence of roughly 2%–3%, particularly in children under 15 years old. 3 Intensive management considerably reduces the possibility of T1DM microvascular and macrovascular complications. 2 In managing DM, the use of drugs has its drawbacks, such as drug dependency, drug resistance, and adverse effects if used for a long time. As a result, there has been a rise in the development of non-medical measures not just to manage T1DM but also to prevent its consequences in recent years. 1
Reflexology is a therapeutic practice that involves massaging or applying pressure to specific reflex areas on the hands and feet. These reflex areas are located on the soles, palms, tops, and sides of the hands and feet. Each reflex area corresponds to a particular part of the body. 4 Stimulating these reflex areas can enhance blood and energy circulation, promote relaxation, and help maintain homeostasis, which in turn supports the body’s ability to overcome various health conditions. 5 Literature suggests that reflexology reduces neuropathic pain and improves glycemic control, nerve conductivity, and thermal and vibration sensitivities. 6 Likewise, foot reflexology has been shown to improve foot impairment, 7 plantar distribution, electrical activity of muscles, 8 peripheral neuropathy, and glycemic control 9 in patients with diabetes. Although one of our previous studies reported the effect of reflexology on the pancreatic area of the palms (R-PAP) on RBG level in type 2 diabetes mellitus (T2DM), 10 no known studies reported the immediate effects of R-PAP in children with T1DM. As reflexology to R-PAP has been shown to reduce blood glucose levels in T2DM in our earlier studies, we hypothesize that it might also be useful in reducing blood glucose levels in T1DM. Hence, in this pilot study, we have adopted a similar methodology used in our previous study, 10 with the objective to evaluate the effect of R-PAP on blood glucose levels in different study participants, that is, patients with T1DM.
Methods
Study design
A single-group pre-test and post-test pilot study was adopted based on our previous study. 10 Fifty participants with T1DM were recruited and underwent R-PAP for 10 min. Assessments were performed before and after the intervention.
Participants
Using a convenient sampling technique, 50 participants (32 females, 18 males) with T1DM, aged 9.22 ± 2.45 years, were recruited from the Institute of Child Health and the Hospital for Children at Egmore, Chennai, India. Male and female participants with T1DM who are willing to participate in the study were included. Participants with end-organ damage (gangrene, toes, or foot amputation) due to diabetes and diabetic ketoacidosis, open wounds and skin disease on the hands and palms, history of allergies, or sensitivity to contact with the palms were excluded from this study. The study protocol was approved by the Institutional Ethics Committee (Ref. No.: RES/IEC-GYNMC/2022/134) of Government Yoga and Naturopathy Medical College, Chennai, India. The study was explained to the participants and their parents beforehand, and written informed consents were obtained from the parents of all participants to participate in the study.
Assessments
Random blood glucose levels
The assessment was conducted using a portable glucometer (GlucoRite; Phoenix Innovative Healthcare Manufacturers Pvt. Ltd., Navi Mumbai, India). To perform the assessment, a drop of capillary blood was obtained by pricking a finger with a lancet and placed on a disposable test strip attached to the glucometer. Measurements were taken immediately before and right after a 10-min intervention. 10
Intervention
In this study, all participants were subjected to a single session of reflexology focused on the pancreatic area of both palms. Each session lasted for a total duration of 10 min, comprising 5 min of reflexology applied to the right palm followed by 5 min on the left palm. The application of moderate pressure during the reflexology intervention was kept within tolerable limits as reported by the patients. This intervention was conducted by a qualified naturopathic physician who possessed 5 years of clinical experience specifically in reflexology treatment. 10
Location of the palm reflex area of the pancreas
It is situated on the palms of the hand, positioned between the fourth and fifth metacarpal bones, just above the area that lies between the tips of the little and ring fingers when making a fist (Fig. 1).10,11
The location of the palm reflex area of the pancreas.
Data analysis
Data were analyzed using a paired-samples t-test with the Statistical Package for the Social Sciences, version 16. A significance level of P <0.05 was deemed statistically significant.
Results
A total of 50 T1DM patients participated in the study. The baseline and demographic details of the study participants are provided in Table 1. There was a statistically significant reduction in RBG levels (from 314.92 ± 113.42 to 302.02 ± 112.94; effect size [d] = 0.114; P = 0.004) after the intervention compared to baseline assessment (Fig. 2). The intervention was tolerable, and none of the subjects reported any adverse effects during the study period.
Baseline and demographic details of the study (n = 50) group
Pre-test and post-test assessments of the reflexology group (n = 50).
Discussion
T1DM is a major health hazard that impairs glucose homeostasis. If untreated, insulin insufficiency causes a metabolic imbalance that worsens over time and results in ketoacidosis, starvation, and death. 2 Reflexology has been chosen by most people to treat their body health problems because it is safe and effective. It also offers natural treatment without consuming drugs, and it is easy to use. Learning reflexology and its application is quite easy; there is no limitation for people to apply it anytime and anywhere. 5 Although many studies found the effect of foot reflexology in T2DM,6–9 studies on hand reflexology are limited in T2DM, 10 and no known study has been conducted in T1DM. Thus, the present study was carried out to find the effect of a single reflexology point called the pancreatic area of the palms on RBG in patients with T1DM.
The results of the study showed a significant reduction in RBG levels in the post-test assessment compared to the pre-test assessment. It indicates that 10 min of R-PAP is effective in reducing blood glucose levels in patients with T1DM. However, a small effect size in the study and a lack of a control group indicate that the magnitude of the reduction in blood glucose level might be very minimal, and it might be due to a placebo effect or their conventional management, including insulin, and not merely due to the R-PAP, respectively. Hence, the results of this study should be treated cautiously, and further sham-controlled studies are recommended to validate the results of the study.
The possible mechanism of action of R-PAP on blood glucose levels is as follows: (1) reflexology treats by “stimulating” reflex points or zones on one particular part of the body that are linked to others through a network of channels, neurons, or transmitters. Thus, when manual pressure was given to pancreatic area of palm in reflexology, the corresponding internal organ (i.e., pancreas) might have been stimulated, which in turn reduced the blood glucose levels 11 ; (2) touch helps people to relax by releasing endorphins and neuropeptides like serotonin and dopamine, which decrease the stress hormones cortisol (glucocorticoids), epinephrine, and norepinephrine, which in turn reduced the blood glucose levels10,12; (3) reflexology reduces stress response and induces relaxation response, which in turn enhances the parasympathetic dominance and sympathovagal balance and helps to improve the insulin secretion from the pancreas and insulin sensitivity at the tissues.5,10 Moreover, the results of this study are supported by previous studies on reflexology in T2DM.6,9,10,13
Strength of the study
This is the first-ever study evaluating the effect of R-PAP in patients with T1DM. The intervention was cost-effective, easy, tolerable, and safe, and no adverse events were reported by the patients.
Limitations of the study
The relatively small sample size, sample size was not calculated based on the previous study, absence of a control group, only one session of R-PAP with no follow-up period, lack of other objective variables like fasting and postprandial blood glucose levels, glycated hemoglobin levels, and continuous blood glucose monitoring are major limitations of the study. A minimum of 3 months intervention with a larger sample size, increased duration and frequency of intervention, and more biochemical markers and a sham-control design are recommended to rule out the placebo effect and the actual effect of R-PAP on blood glucose level and its mechanism in T1DM.
Conclusions
Ten minutes of R-PAP might have some effect in reducing blood glucose levels in children with T1DM. Small sample size, short intervention duration, no follow-up, minimum effect size, and a lack of a control group and other biomarkers are limiting the scope of this study. Hence, the results of this study should be treated cautiously, and further studies are recommended to validate the study results.
Authors’ Contributions
S.S.: Conceptualization, data curation, investigation, and writing—original draft. A.M.: Conceptualization, data curation, formal analysis, methodology, software, supervision, validation, visualization, writing—original draft, and writing—review and editing. S.E.C.: Conceptualization, methodology, project administration, supervision, and writing—review and editing. R.L.: Conceptualization, data curation, investigation, and supervision. N.M.: Conceptualization, supervision, and visualization. S.H.: Conceptualization, methodology, and investigation. V.T.: Conceptualization, investigation, and supervision. S.E.: Conceptualization, supervision, visualization, and resources. N.M.: Conceptualization, supervision, visualization, and resources.
Footnotes
Author Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received for this article.