Advances in Integrative Medicine 10 (2023) 152–156

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Effect of reflexology at pancreatic area of palms on blood glucose levels in

patients with type 2 diabetes mellitus: A randomized controlled study
S. Shobanadevi a, Mooventhan Aruchunan b, *, N. Mangaiarkarasi a, K. Kahlilsubramanian b,
N. Manavalan c
a
Department of Acupuncture and Energy Medicine, Government Yoga and Naturopathy Medical College, Chennai, Tamilnadu, India
b
Department of Research, Government Yoga and Naturopathy Medical College, Chennai, Tamilnadu, India
c
Department of Naturopathy, Government Yoga and Naturopathy Medical College, Chennai, Tamilnadu, India

A R T I C L E I N F O A B S T R A C T

Keywords: Introduction: Diabetes mellitus is one of the most prevalent metabolic diseases. Reflexology is a form of treatment
CAM which involves giving massage or pressure to the particular points of the feet and hands. This study was per­
Diabetes formed to find the effect of reflexology at pancreatic area of palms (RPP) on random blood glucose levels in
Reflexology
patients with type 2 diabetes mellitus (T2DM).
Materials and methods: This study was done at Government Yoga and Naturopathy Medical College, Chennai,
India. A total of 100 participants with T2DM were randomly allocated to reflexology group (RG) (n = 50) and
control group (CG) (n = 50). RG underwent only one session of RPP for the duration of 20-min (10-min to right
palm followed by 10-min to left palm), while the CG was on rest in sitting posture for the duration of 20-min.
Random blood glucose levels (RBG) were assessed before and after the intervention.
Results: Inter group analysis showed a significant reduction in RBG levels in the RG (z = 4.606; p < 0.001; Effect
size: d = 0.243), unlike CG (t = 0.668; p = 0.507; Effect size: d = 0.023). However, between-groups analyses did
not show a significant difference in RBG levels between the groups (z = 1.406, p = 0.160; Effect size: d = 0.307).
None of the participants reported any adverse events during or after the study.
Conclusion: RG reduces RBG levels with a small effect size compared to CG. Thus, twenty minutes of RPP might
have some effect in reducing blood glucose levels in patients with T2DM. However, further studies are required
to warrant the results of this study.

1. Introduction low-to-middle-income countries [6]. Patients with T2DM have a 15 %

increased risk of all-cause mortality compared with people without
Diabetes mellitus is a group of metabolic disorders characterized by diabetes [7]. In the conventional management of T2DM, use of drugs has
chronic hyperglycemia due to relative insulin deficiency or resistance or its own drawbacks, such as drug dependency, drug resistance and
both [1]. American Diabetes Association (ADA) classified the diabetes as adverse effects, if used for a long time. Hence, in recent years there has
type 1 diabetes mellitus (β-cell destruction, usually leading to absolute been an intense search for non-medical measures not only to manage the
insulin deficiency), type 2 diabetes mellitus (T2DM) (ranging from T2DM, but also to prevent its complications [1].
predominantly insulin resistance with relative insulin deficiency to Reflexology is a form of treatment which involves giving massage or
predominantly an insulin secretory defect with insulin resistance), other pressure to the particular points called as the ‘reflex areas” of the feet
types, and gestational diabetes mellitus [2,3]. According to the World and hands. Reflex areas found on the soles, palms, the top and the sides
Health Organization (WHO), 90 % of diabetes mellitus cases are T2DM, of the feet and hands are acts as the sensors and each area is linked with
mainly due to deficient insulin secretion by pancreatic islet β-cells, tissue a specific part of the body. By applying the reflexology technique these
insulin resistance (IR) and an inadequate compensatory insulin secre­ sensors are stimulated in order to improve the blood and energy circu­
tory response [4,5]. Incidence and prevalence of T2DM vary according lation, give sense of relaxation, and maintain the homoeostasis, which in
to geographical region, with more than 80 % of patients living in turn helps the body systems to return to its natural state treat and to treat

* Correspondence to: Department of Research, Government Yoga and Naturopathy Medical College, Arumbakkam, Chennai 600106, Tamilnadu, India.
E-mail address: [Link]@[Link] (M. Aruchunan).

[Link]
Received 15 October 2022; Received in revised form 14 July 2023; Accepted 16 September 2023
Available online 20 September 2023
2212-9588/© 2023 Elsevier Ltd. All rights reserved.

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S. Shobanadevi et al. Advances in Integrative Medicine 10 (2023) 152–156

the associated diseases [8]. before and after the intervention (Figs. 1 and 2).
Literature suggests that reflexology reduces pain and anxiety and
improves quality of life in cancer; [9] reduces seizure frequency, and 2.2. Study settings
improve the quality of life in intractable epilepsy; and reduces the
neuropathic pain and improve quality of life and functional capacity in This study was carried out at Department of Acupuncture and Energy
patients with T2DM [10–12]. Likewise, foot reflexology has shown to Medicine, Government Yoga and Naturopathy Medical College and
improve feet impairment, [13] plantar distribution, electrical activity of Hospital, Chennai, India.
muscles, [14] peripheral neuropathy and glycemic control [15] in pa­
tients with diabetes. However, there is a lack of scientific evidence 2.3. Participants
reporting the effects of hand reflexology in people with T2DM. Hence,
this study was performed to find the effect of hand reflexology at a A total of one hundred participants with T2DM fulfilled the eligibility
specific point called “pancreatic area of palms” (RPP) on blood glucose criteria were included for the study from the outpatients department of a
levels in patients with T2DM. yoga and naturopathy medical college and hospital, located in South
India using a convenient sampling. Eligibility criteria: Males and females
2. Materials and methods T2DM participants aged 18 years and above and willing to give their
consent to participate in the study were included. Participants with
2.1. Study design T1DM, GDM and other types of diabetes, and T2DM complications, open
wound and skin disease on the hands and palms, and history of allergies
This is a randomized controlled study. Recruited participants (n = or sensitivity to contact with the palms were excluded from the study.
100) were randomly allocated to reflexology group (RG) (n = 50) and The study protocol was approved by the institutional ethics committee
control group (CG) (n = 50). RG underwent only one session of reflex­ of Government yoga and naturopathy medical college, Chennai, Tam­
ology at pancreatic area of both palms, while the CG was on rest in ilnadu, India (Ref. no.: RES/IEC-GYNMC/2021/113). The study was
sitting posture for the duration of 20 min. Assessments were performed explained to the participants before commencement of the study in

Fig. 1. Trial Profile. Note: RBG = Random blood glucose levels.

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S. Shobanadevi et al. Advances in Integrative Medicine 10 (2023) 152–156

Within group analysis was performed using paired samples t-test (nor­
mally distributed data), and Wilcoxon Signed Ranks Test (not normally
distributed data) and between groups analyses was performed using
independent samples-t-test (normally distributed data) and Mann-
Whitney U-test (not normally distributed data) with the use of statisti­
cal package for the social sciences (SPSS), version-16. Effect size for
within-group and between groups were analyzed using G*Power
[Link]. p-value ˂ 0.05 was considered as a significant result.

3. Results

Out of 130, 100 participants fulfilled the eligibility criteria and

included in the study. Participants were randomly divided into RG and
CG through computerized randomization. All baseline and demographic
variables were comparable and no significant difference exists between
the groups (Table 1). Inter group analysis showed a significant reduction
in RBG levels in the RG (z = 4.606; p < 0.001; Effect size: d = 0.243),
unlike CG (t = 0.668; p = 0.507; Effect size: d = 0.023). However,
between-groups analyses did not show a significant difference in RBG
levels between the groups (z = 1.406, p = 0.160; Effect size: d = 0.307).
None of the participants reported any adverse events during or after the
study.
Fig. 2. Pre-test and post-test assessments of reflexology group (n = 50) and
control group (n = 50). Note: *= p-value < 0.001 in within group (Wilcoxon 4. Discussion
Signed Ranks Test). Within group analysis: Reflexology group (z = 4.606;
p < 0.001), and control group (t = 0.668; p = 0.507). Between group analysis
Reflexology has been chosen by most people to treat their body
by Mann-Whitney U test (z = 1.406, p = 0.160).
health problems because it is safe and effective. It also offers natural
treatment without consuming drugs and it is easy to use.1 Learning
detail and all participants voluntarily gave their written-informed con­ reflexology and its application is quite easy, there is no limitation for
sent to participate in the study. people to apply it anytime and anywhere [8]. Though many studies
found the effect of foot reflexology in T2DM, [13–15] studies on hand
2.4. Assessments reflexology is limited. Thus, the present study was carried out to find the
effect of a single reflexology point called pancreatic area of palms on
Random blood glucose (RBG) levels were assessed using a portable RBG in patients with T2DM. Results showed a significant reduction in
glucometer (GlucoRite) through capillary blood just before (pre-test) RBG levels in RG, unlike CG in the inter group analysis. It indicates that
and immediately after (post-test) the intervention. the 20 min of RPP may be useful in reducing the blood glucose levels in
patients with T2DM. The reduction in the blood glucose levels in the RG
2.5. Intervention might attribute to the following reasons: Each and every organ of the
body is thought to link with specific areas of the palms and soles.
2.5.1. Reflexology group (RG) Reflexology treats by ’stimulating’ reflex points or zones on one
The recruited subjects received only one session of reflexology at particular part of the body that appear to link spontaneously to others
pancreatic area of both the palms for the duration of 20 min (10 min to through a network of channels, neurones, or transmitters. Thus, when
right palm followed by 10 min to left palm) by an institutionally qual­ manual pressure was given to pancreatic area of palm in reflexology, the
ified yoga and naturopathy physician with 5 years of experiences in corresponding internal organ might have been stimulated through the
clinical reflexology. The Location of the palm reflex area of the pancreas: It nerve endings that are present in the palms and soles. Reflexology, like
is located on the palms of the hand, between the 4th and 5th metacarpal massage, shiatsu, aromatherapy, and osteopathy, is a touch therapy,
bones just above the spot that lies in-between the tips of little and ring hence, it is therapeutic effects are mostly due to the impact of touch in
finger when we make a fist. general [16]. Touch helps people to relax by releasing endorphins and

2.5.2. Control group (CG) Table 1

The recruited subjects of this group received no interventions and Baseline and demographic details of the study (n = 50) and control (n = 50)
asked to sit quietly in a treatment room for 20 min. groups.
Parameters Study group Control group p-
2.6. Randomization and blinding value

Age (years) † 52.76 ± 9.11 50.48 ± 11.39 0.272

All the subjects were randomly assigned to either a RG or a CG using Gender 16 female 34 26 female 24
computerized randomization with random allocation ratio of 1:1. male male
Random allocation concealment was done using SNOSE (Sequentially Height (cm) † 1.61 ± 0.09 1.60 ± 0.07 0.517
numbered, opaque, sealed envelope) technique. Randomization was Weight (kg) † 69.16 ± 9.31 69.606 ± 13.56 0.850
Body mass index (kg/m2) † 26.48 ± 1.98 27.04 ± 4.81 0.445
performed by one of the authors who were not involved in the assess­
Systolic blood pressure ⁋ 129.66 ± 14.42 128.28 ± 12.63 0.620
ments. Neither the subjects nor the investigators were blinded to the RG Diastolic blood pressure ⁋ 83.70 ± 7.23 83.48 ± 10.69 0.550
and CG. Random blood glucose levels 227.10 ± 96.14 236.5 ± 100.32 0.521
(mg/dl) ⁋
2.7. Statistical analysis *All values are in mean ± standard deviation except gender (values are in fre­
quency).
Data were checked for normality using Kolmogorov-Smirnov test. † = Independent samples-t-test; ⁋ = Mann-Whitney U-test.

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S. Shobanadevi et al. Advances in Integrative Medicine 10 (2023) 152–156

neuropeptides like serotonin and dopamine, which decrease the stress Author statement
hormones cortisol (glucocorticoids), epinephrine, and norepinephrine
which in turn may help to reduce blood glucose levels in the body [17]. The conception and design of the study: SS, MA, KK. Acquisition of
Previous studies suggests that 12 sessions of foot reflexology was data, or analysis and interpretation of data: SS, MA, MN. Drafting the
effective in improving feet impairment of people with T2DM compared article or revising it critically for important intellectual content: SS, MA,
to control group (i.e. those received guidelines on foot self-care); [13] 10 MN, KK. Final approval of the version to be submitted: SS, MA, MN, KK,
sessions of foot reflexology was effective in improving plantar distri­ MN.
bution and electromyogram (i.e. maximum peak electrical activity,
median frequency and forefoot area) in T2DM [14]. Likewise, a study by Ethical statement
cicek et al., reported that 12 weeks of foot reflexology had a medium
effect size in improving diabetic peripheral neuropathy and glycemic The study protocol was approved by the institutional ethics com­
control in older adults with diabetes [15]. These literatures support the mittee of Government yoga and naturopathy medical college, Chennai,
positive impact of the reflexology in T2DM. Tamilnadu, India (Ref. no:RES/IEC-GYNMC/2021/113).
Intra group analysis of the present study showed no significant dif­
ference in between the groups. It indicates that though RPP reduces
Conflict of interest
blood glucose level compared to its respective pre-test, the reduction
was not significant compared to control intervention. However, the ef­
None declared.
fect size derived using the inter group showed small effect (i.e. a small
magnitude of reduction in RBG) in RG, while nearly no effect in CG. In
addition, the intra group analysis also confirmed the small magnitude of
Declaration of Competing Interest
reduction in RBG levels in RG compared to CG. It indicates that even
though the reduction in RBG was not statistically significant in RG
We wish to confirm that there are no known conflicts of interest
compared to CG, RG reduces RBG levels with small effect size compared
associated with this publication and there has been no significant
to CG. This might attribute to the following reasons: The effect of the
financial support for this work that could have influenced its outcome.
reflexology depends on various factors like the accuracy of the chosen
We confirm that the manuscript has been read and approved by all
point, depth of activity on the point, duration and the environmental
named authors and that there are no other persons who satisfied the
factors. Practically, it was difficult to control all these factors for all the
criteria for authorship but are not listed. We further confirm that the
patients involved in the study. And, the pressure variation based on the
order of authors listed in the manuscript has been approved by all of us.
pain threshold of the patients might have also influenced the results,
We confirm that we have given due consideration to the protection of
because literature suggests that light pressure and a more standard
intellectual property associated with this work and that there are no
pressure of reflexology may produces different effects in the body [18].
impediments to publication, including the timing of publication, with
Variation (as reflected in standard deviation) in the blood glucose levels
respect to intellectual property. In so doing we confirm that we have
present among the samples data; sample size or the duration of the
followed the regulations of our institutions concerning intellectual
intervention might have not been sufficient enough to produce a sig­
property.
nificant effect and larger effect size.
We further confirm that any aspect of the work covered in this
manuscript that has involved either experimental animals or human
4.1. Strength of the study patients has been conducted with the ethical approval of all relevant
bodies and that such approvals are acknowledged within the
To our knowledge this is the first-ever randomized controlled trial manuscript.
performed to find the effect of a single reflex point i.e. pancreatic area of We understand that the Corresponding Author is the sole contact for
palms on blood glucose levels in T2DM. None of the participants re­ the Editorial process (including Editorial Manager and direct commu­
ported any adverse events during or after the study. nications with the office). He/she is responsible for communicating with
the other authors about progress, submissions of revisions and final
4.2. Limitations of the study approval of proofs. We confirm that we have provided a current, correct
email address which is accessible by the Corresponding Author and
The duration (20 min; 10 min of each palm) and frequency (only one which has been configured to accept email from ([Link]@g­
session) of intervention might not be sufficient enough to produce a [Link]) Signed by all authors as follows:
significant differences across groups. Sample size was small, sample size
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