Resources and Strategies

The Evidence-Informed Chiropractor

 

Week 7 - Diabetes

 

 

There is a crisis in the U.S. but few are taking individual action to change. The crisis is the dramatic increase in Type 2 diabetes (which now occurs even in children and adolescents).

Researchers have estimated that for individuals born in the U.S. in 2000, the lifetime probability of being diagnosed with diabetes for males was 33% and for females 39%!

Venkat Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF. Lifetime risk for diabetes mellitus in the United States. JAMA 2003;290:1884-1890.

The solution is simple but difficult to accomplish:
Change to a primarily fruit and vegetable-based diet and exercise.

Without exaggeration, patients would rather lose their eyesight, lose their toes, increase their chance of cardiac and renal disease and failure rather than change!

Why, because initially, diabetes doesn't hurt and the treatment, initially doesn't hurt. Do you know, though, that many patients who do not change their diet and exercise (regardless of whether they take their medication) will move to insulin injections?

The American Diabetes Association and the National Institute of Diabetes and Digestive and Kidney Diseases issued a position statement urging that patients be evaluated for pre-diabetes and managed prior to the development of diabetes and its associated health consequences. That management for pre-diabetes is diet and exercise.

American Diabetes Association. The prevention or delay of type 2 diabetes. Diabetes Care 2002;25:742-749.


But Type 2 diabetes develops asymptomatically, so how can you know if a patient has diabetes if they have no pain complaints?

The history provides sensitive clues.

Type 2 Diabetes


Although, when asked, most doctors would list the polys (i.e. polyuria, polydypsia, and polyphagia) as the primary history clues for diabetes, they do not realize that this is true mainly for type 1 diabetes and later stages of type 2 diabetes. (This is the value of the Review of Systems form)

For type 2 diabetes, the three most common complaints are

  • fatigue
  • numbness and tingling (usually the distal extremities), and
  • vision that changes throughout the day (e.g. blurry then clear)
For females, an additional clue is frequent yeast infections.

American Diabetes Association (ADA). Standards of medical care in diabetes IV. Prevention/delay of type 2 diabetes. Diabetes Care. 2007;30:S7-S8.


So now I suspect my patient has diabetes.
  • What do I do next?
  • Don't patients have to take drugs to control their diabetes?

Your suspicion must be confirmed with lab testing (whether you order or refer-out for testing). Fasting blood glucose levels of 126 mg/dL or higher on more than one occasion is confirmatory. But remember that fasting levels of 100 mg/dL to 125 mg/dL indicates pre-diabetes; the best time to initiate diet and exercise changes.

Obviously, if a patient is already on prescription medication for their diabetes, any change must be dictated by the prescribing doctor

 

However . . .

 

There is clear scientifc evidence that the harder choice for patients (diet and exercise) can be as effective as medication! Here are but a few examples.

Results from a monumental study by the Diabetes Prevention Program Research Group comparing the effect of lifestyle versus metformin versus placebo in the reduction of incidence of type 2 diabetes were recently reported.

The surprise to many was that the reduction of the incidence of diabetes was 58% for those on the lifestyle intervention compared to 31% for those using metformin. Although this is similar to other reports such as the Finland (Tuomeielehto ref) and China (Pan ref) reports, the effects were more dramatic. The researchers suggest that the primary reason may be the individualized approach used in their study.

In addition to a low carbohydrate, low-fat diet, participants engaged in physical activity of moderate intensity (such as brisk walking) for at least 150 minutes per week. They also participated in a 16-hour curriculum designed to support the changes in diet, exercise, and behavior modification. The goal was to maintain a weight reduction of at least 7% of the initial body weight.

Another sutdy:
A 12-year follow-up study of over 42,000 males involved a comparison between two dietary regimens and the relative risk of type 2 diabetes. The researchers concluded that a western dietary pattern (i.e. high in red meat, fat, refined, grains, and sweet/deserts) combined with low physical activity or obesity substantially increased the risk of type 2 diabetes compared to a“prudent” dietary pattern (i.e. high consumption of vegetables, fruit, fish, poultry, and whole grains).

Yet another:
There is some evidence that these foods have either high phenol content or have effects on enzymes involved in glucose metabolism. Foods include yogurt (in particular soy and fruit yogurts), pumpkins, cramberries, and fenugreek1-3. Taken together, this data seems to indicate that a diet including more fruits, vegetables, soy, and perhaps yogurt may be beneficial especially in substitution for other commonly consumed foods in the traditional American diet.

Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with liefestyle intervention or metformin. N Engl J Med 2002;346:393-401.

Tuomilehto J, Lindsrohm J, Erikson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:143-150.

Pan XR, Li GW, Hu YH, et al. Effect of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: the DaQing IGT and Diabetes Stud. Diabetes Care 1997;20:537-544.


Apostolidis E, Kwon YI, Shetty K. Potential of cranberry-based herbal synergies for diabetes and hypertension management. Asia Pac J Clin Nutr. 2006;15(3):433-441.

Kwon YI, Apostolidis E, Kim YC, Shetty K. Health benefits of traditional corn, beans, and pumpkin: in vitro studies for hyperglycemia and hypertension management. J Med Food. Jun 2007;10(2):266-275.

Kwon YI, Apostolidis E, Shetty K. In vitro studies of eggplant (Solanum melongena) phenolics as inhibitors of key enzymes relevant for type 2 diabetes and hypertension. Bioresour Technol. Aug 10 2007.

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