The Impact of Latihan Pasrah Diri / Self Surrender Practice (LPD) in Sleep Quality and Inflammatory Markers in Diabetes Mellitus Type 2 Patients Without Depression: A Randomized Controlled Trial.

Background: Insomnia is more frequent in type 2 diabetes mellitus (T2DM) patients. Both conditions are known to cause low-grade inflammation and an independent risk factor for cardio-cerebrovascular events (CCDs) and overall mortality. Relaxation, mindfulness, breath control, and spiritual-based therapies such as Latihan Pasrah Diri / Self Surrender Practice (LPD) have been known to induce relaxation, improve depressive symptoms and sleep quality, inflammatory markers, glycemic control, Daily Living Activities (DLA), and Quality of Life (QoL) in T2DM patients. It is currently unknown whether LPD can improve sleep quality in patients with T2DM without depression and its association with inflammation.

Objectives: Determine the effect of LPD on sleep quality and inflammatory markers in T2DM patients without depression.

Method: This is a prospective, single-blind, randomized controlled trial. Patients aged 30-60 years old, Muslim, diagnosed with type 2 diabetes mellitus and who were not currently experiencing depression (Beck Depression Inventory-II Score <17) were eligible to be included in the study. We assessed the changes in the value of the ΔInsomnia Severity Score (ΔISI) and inflammatory markers (Δhs-CRP, ΔMPV, and ΔNLR). The intervention group was the group with standard therapy of DM and LPD, while the control group was the group with standard therapy of DM without LPD. The intervention was carried out 2 times a day with 20 minutes for each session, for 8 weeks.

Result: A total of 44 subjects were randomized 1: 1 into intervention (n = 22) and control (n = 22) groups. In the intervention group, only 12 subjects met the minimum frequency of intervention, thus being included in the statistical analysis. There was a statistically significant decrease of ΔISI score by 2.58 compared to 0.04 (P = .003; 95% CI -4.15, -0.92), decrease of ΔMPV by 0.41 and 0.03 (P = .001; 95% CI -0.59, -0.18), and change of ΔNLR by -0.4 compared to 0.15 (P = .035; 95% CI -0.93, -0.03) in the intervention group compared to the control group. There was no significant change in Δhs-CRP (P = .762; 95% CI -5.44, 4.02) in the intervention group compared to control.

Conclusion: Eight weeks of LPD improves sleep quality and reduces inflammatory markers (MPV and NLR) in T2DM patients without depression. Whether changes in inflammatory markers and insomnia are related and whether improvements in insomnia lead to improvements in inflammatory markers or vice versa requires further study.

Limitations: Direct supervision on the diet and physical activity of the subjects was not done due to some obstacles in the field.