Algorithm for complementary and alternative medicine practice and research in type 2 diabetes

Bastyr University, Kenmore, WA 98028, USA.
The Journal of Alternative and Complementary Medicine (Impact Factor: 1.59). 01/2007; 13(1):159-75. DOI: 10.1089/acm.2006.6207
Source: PubMed


To develop a model to direct the prescription of nutritional and botanical medicines in the treatment of type 2 diabetes for both clinical and research purposes.
Available literature on nutritional and botanical medicines was reviewed and categorized as follows: antioxidant/anti-inflammatory; insulin sensitizer; and beta-cell protectant/insulin secretagogue. Literature describing laboratory assessment for glycemic control, insulin resistance, and beta-cell reserve was also reviewed and a clinical decision tree was developed.
Clinical algorithms were created to guide the use of nutritional and botanic medicines using validated laboratory measures of glycemic control, insulin sensitivity, and beta-cell reserve. Nutrient and botanic medicines with clinical trial research support include coenzyme Q10, carnitine, alpha-lipoic acid, N-acetylcysteine, vitamin D, vitamin C, vitamin E, chromium, vanadium, omega-3 fatty acids, cinnamon (Cinnamomum cassia), fenugreek (Trigonella foenum-graecum), and gymnema (Gymnema sylvestre).
Clinical algorithms can direct supplementation in clinical practice and provide research models for clinical investigation. Algorithms also provide a framework for integration of future evidence as it becomes available. Research funding to investigate potentially beneficial practices in complementary medicine is critically important for optimal patient care and safety.

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    • "There are several additional limitations to our study: 1) because our study population was mainly Caucasian and relatively well educated, the results may not apply to regions with different demographic characteristics, 2) our study was conducted in a managed care setting that imposed some constraints on ND practices (e.g., NDs could not directly order additional laboratory tests for GH patients or prescribe medications without approval of the patient’s GH primary care provider), and 3) because dietary supplements are not covered by insurance, many participants reported they did not use the supplements recommended by the ND, which may have reduced the potential clinical benefits of ANC. For example, although the clinical effectiveness of many dietary supplements remains unknown, omega-3 fatty acids have strong evidence for improving outcomes in people with high cardiovascular risk and small, randomized trials suggest chromium, cinnamon and coenzyme Q10 reduce blood glucose and improve other risk factors for developing complications of diabetes [29-33]. "
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    ABSTRACT: Several small, uncontrolled studies have found improvements in self-care behaviors and reductions in clinical risk in persons with type 2 diabetes who received care from licensed naturopathic physicians. To extend these findings and determine the feasibility and promise of a randomized clinical trial, we conducted a prospective study to measure the effects of adjunctive naturopathic care (ANC) in primary care patients with inadequately controlled type 2 diabetes. Forty patients with type 2 diabetes were invited from a large integrated health care system to receive up to eight ANC visits for up to one year. Participants were required to have hemoglobin A1c (HbA1c) values between 7.5-9.5 % and at least one additional cardiovascular risk factor (i.e., hypertension, hyperlipidemia or overweight). Standardized instruments were administered by telephone to collect outcome data on self-care, self-efficacy, diabetes problem areas, perceived stress, motivation, and mood. Changes from baseline scores were calculated at 6- and 12-months after entry into the study. Six and 12-month changes in clinical risk factors (i.e., HbA1c, lipid and blood pressure) were calculated for the ANC cohort, and compared to changes in a cohort of 329 eligible, non-participating patients constructed using electronic medical records data. Between-cohort comparisons were adjusted for age, gender, baseline HbA1c, and diabetes medications. Six months was pre-specified as the primary endpoint for outcome assessment. Participants made 3.9 ANC visits on average during the year, 78 % of which occurred within six months of entry into the study. At 6-months, significant improvements were found in most patient-reported measures, including glucose testing (P = 0.001), diet (P = 0.001), physical activity (P = 0.02), mood (P = 0.001), self-efficacy (P = 0.0001) and motivation to change lifestyle (P = 0.003). Improvements in glucose testing, mood, self-efficacy and motivation to change lifestyle persisted at 12-months (all P < 0.005). For clinical outcomes, mean HbA1c decreased by -0.90 % (P = 0.02) in the ANC cohort at 6-months, a -0.51 % mean difference compared to usual care (P = 0.07). Reductions at 12-months were not statistically significant (-0.34 % in the ANC cohort, P = 0.14; -0.37 % difference compared to the usual care cohort, P = 0.12). Improvements were noted in self-monitoring of glucose, diet, self-efficacy, motivation and mood following initiation of ANC for patients with inadequately controlled type 2 diabetes. Study participants also experienced reductions in blood glucose that exceeded those for similar patients who did not receive ANC. Randomized clinical trials will be necessary to determine if ANC was responsible for these benefits.
    BMC Complementary and Alternative Medicine 04/2012; 12(1):44. DOI:10.1186/1472-6882-12-44 · 2.02 Impact Factor
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    • "However, recent in-vitro and in-vivo research has discovered new potential properties of several cinnamon species. • The treatment of diabetes (type 2) seems to be the most promising field of research for cinnamon [15] [39] [69] [101] [412]. Although there are conflicting results from two randomized studies, the results from in-vitro and animal studies indicate significant hypoglycemic effects. "
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    ABSTRACT: An evidence-based systematic review of cinnamon (Cinnamomum spp.), including written and statistical analysis of scientific literature, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing, by the Natural Standard Research Collaboration is discussed in this monograph.
    Journal of Dietary Supplements 12/2011; 8(4):378-454. DOI:10.3109/19390211.2011.627783
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    • "This is shown in the evidence-based practice for Dietitians[2]. Antioxidants including glutathione (GSH), vitamin C and vitamin E amongst others have been identified as nutritional ingredients necessary for DM management[3]. The risk of harm from pro-oxidant radical forms of antioxidant vitamins is not in doubt. "
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    ABSTRACT: Antiplatelet and antioxidant nutritional therapies (ANT) are commonly used in diabetes management. Guidelines recommend identifying deficiencies of antioxidant vitamins and condition of no contraindication for nutritional and antiplatelet respectively. To determine whether the guidelines recommendations for diabetes patients to be assessed for (1) antioxidant vitamins' deficiencies and/or (2) whole blood viscosity (WBV) as indication of no antiplatelet contraindication. Laboratory records were audited. 10,342 de-identified glycaemic index (HbA1(c)) requests received in 2008 were sorted into three groups based on level of control. (1) Poor (n = 1962, HbA1(c) ≥ 8.1); (2) Good (n = 5616, HbA1(c) = 6.0 - 8.0) and (3) Excellent (n = 2764, HbA1(c) ≤ 5.9). All 57 cases with haematocrit and total protein results in the poor (n=30) and excellent (n=27) groups were selected for calculation and comparison of WBV levels. None of the two guidelines' recommendations are being followed as no case was requested for any antioxidant vitamin or WBV. Assessments of the latter show that WBV is statistically significantly lower (p < 0.05) in the group with excellent glycaemic control compared to the group with poor glycaemic control. Aspirin is one of the therapies in diabetes management. Its effect is modulated by WBV. ANT is alternative to aspirin and influences WBV. For patients that have full blood count and plasma protein results, WBV can be extrapolated at no extra cost to the health system. There is a need to raise awareness for the recommended guidelines for laboratory monitoring to be followed.
    North American Journal of Medical Sciences 08/2009; 1(3):110-3.
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