Case Report: Patient Centered Care resulting in the reduction in Insulin usage and improvement in Blood-Glucose and A1C Levels using the Dexcom G4 Continuous Glucose Monitoring system in a 26 year old male Type 1 Diabetic, with reduction of anterior head translation, cervical hyperlordosis, thoracic hypokyphosis, and lumbar spondylolistheses

Abstract

Objective: The purpose of this study is to report on the location, analysis, correction of vertebral subluxation in a patient centered model of care and how it resulted in the reduction of insulin usage and the improvement in blood glucose and A1C levels in a patient with Type 1 diabetes.
Clinical features: A 26-year-old male presented for care with pain in the neck and upper back regions. Spinal and postural abnormalities were found, including anterior head translation, hypokyphosis, T8-T9 disc herniation, and multiple spondylolistheses in the lumbar spine. The patient had just begun wearing the Dexcom G4 continuous glucose monitor (CGM). No chiropractic care was rendered to the patient in the first 2 weeks of wearing the G4 CGM monitor. In the first week of wearing the CGM, the average blood glucose was 174 mg/dl in week 1, and 178 mg/dl for week 2 and a reported A1C value was 7.8%.
Intervention and outcomes: With an unaltered diet, the patient was seen 36 times over 8 weeks in which Chiropractic BioPhysics (CBP) technique was applied. The patient achieved a reduction of their cervical hyperlordosis, thoracic hypokyphosis, and lumbar spondylolistheses. During care, the patient’s blood glucose and A1C values improved each week. At the end of week 8, the final average blood glucose was 142 mg/dl and the A1C level was 6.7 %. The patient’s blood was tested for the presence of C-peptides from 2 different labs, at week 5 and 8. It was found to be <.1 ng/ml. The reference range of C-peptide is 0.8-3.1 ng/mL.
Conclusion: CGM allows for diabetics to monitor their blood glucose in real time so that they may alter dietary and lifestyle habits to improve upon their blood glucose levels. Clinical studies conducted by Dexcom showed an average improvement in A1C values of .5% over 6 months, and a maximum reduction of 1% in a 12-month period. This case study demonstrates the successful reduction of global and segmental subluxations, with concurrent reduction in average blood glucose by 30 mg/dl and A1C values by 1.1% in 8 weeks. Further research is suggested for a case series and clinical trials to determine any link between spinal posture, subluxation and sugar metabolism and A1C levels.

Full text

Improved Glycosylated Hemoglobin, Hyperglycemia, and Quality of Life
Following Thoracic Hypokyphosis Vertebral Subluxation Correction Using
Chiropractic BioPhysics®: A Prospective Case Report
Curtis Fedorchuk1*, Douglas F Lightstone1, Robert D Comer1, Michael T Weiner2 and Matthew McCoy3
1Institute for Spinal Health and Performance, 425 Peachtree Parkway Suite 315, Cumming, GA, 30041, USA
2Private Practice, 2347 Brockett Rd, Tucker, GA 30084, USA
3Foundation for Vertebral Subluxation, 4390 Bells Ferry Road Kennesaw, Georgia 30144, USA
*Corresponding author: Curtis Fedorchuk, D.C, Institute for Spinal Health and Performance, 425 Peachtree Parkway Suite 315, Cumming, GA, 30041, USA, Tel: (770)
573-2777; Fax: (770) 888-1176; E-mail: cfedorchuk@comcast.net
Received date: September 19, 2018; Accepted date: October 22, 2018; Published date: October 28, 2018
Copyright: © 2018 Fedorchuk C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Objective: Spinal misalignment increases spinal cord tension and is linked to various health conditions. There
has never been a study on the impact of spinal alignment on blood glucose metabolism. This prospective case with
long-term follow-up explores spinal alignment and its impact on type 1 diabetes mellitus.
Case and methods: A 26-year-old male presented with chronic mid-back pain for 9 years and type 1 diabetes
mellitus. Radiography and MRI revealed hypokyphosis of the thoracic spine with spinal misalignment from thoracic
vertebrae 6 through 9 consistent with vertebral subluxation. Glycosylated hemoglobin and blood-glucose averages
were obtained by continuous glucose monitoring. Back pain, paraspinal muscle tension, and quality of life were also
measured. The patient received Chiropractic BioPhysics® care including Mirror Image® corrective spinal exercises,
adjustments, and traction.
Results: After 36 visits, the patient reported improvement in his mid-back pain and quality of life. Thoracic x-rays
showed correction of thoracic hypokyphosis. Surface EMG measuring paraspinal muscle tension improved and
continuous glucose monitoring showed dramatic drop in blood glucose immediately following the onset of each visit
and improvement in blood glucose averages, percentage of time of blood glucose in a healthy target range, and
glycosylated hemoglobin. The patient reported he reduced his basal insulin by approximately half during chiropractic
care.
Conclusions: This case suggests that correction of thoracic hypokyphosis using Chiropractic BioPhysics® care
protocols may result in improved glycosylated hemoglobin and blood glucose metabolism for a person with type 1
diabetes mellitus, as well as back pain, paraspinal muscle tension, and quality of life.
Keywords: Chiropractic BioPhysics®; Adjustments; Traction;
Vertebral subluxation; spine; Type 1 diabetes; oracic hypokyphosis;
Continuous glucose meter; HbA1c
Introduction
Type 1 diabetes mellitus (T1DM) has serious short-term and long-
term health implications. e disorder has a strong genetic component,
but the factors that trigger onset of clinical disease remain largely
unknown [1]. Hyperglycemia predisposes people with diabetes to
serious health conditions and complications such as cardiovascular
disease, stroke, nephropathy and kidney failure, retinopathy and
blindness, neuropathy, depression, infections and amputations, and
premature death [1-11]. T1DM is a disease “with substantial risk of
long-term morbidity and mortality. For example, a report from the US
Centers for Disease Control [CDC] recently estimated that a 10-year-
old boy or girl developing [type 1] diabetes in the year 2000 would
lose, on average, 18.7 and 19.0 life-years, respectively, compared with
their non-diabetic peers [12]”.
ere is no known way to prevent or cure T1DM. Advancements in
newer treatment approaches have facilitated improved outcomes in
terms of both glycemic control and reduced risks for development of
complications. Nonetheless, major challenges remain in the
development of approaches to the prevention and management of
T1DM and its complications [1].
Chiropractic is a health care discipline rooted in the philosophy
optimal health and performance is sustained by neurological and
spinal health. Conversely, neurological stress and strain contribute to
disease and dysfunction and are preceded by abnormal, unhealthy
spinal alignment and posture known as vertebral subluxations.
Vertebral subluxation involves a biomechanical dysfunction and a
neurological compromise [13,14]. is includes rotational or
translational displacements of the spine away from normal spinal
alignment in any anatomical plane accompanied by neurologic
dysfunction. Correction of vertebral subluxations toward a healthy
spinal alignment can alleviate the associated pain or neurologic
dysfunction [15-18].
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ISSN: 2155-6156
Journal of Diabetes and Metabolism Fedorchuk et al., J Diabetes Metab 2018, 9:10
DOI: 10.4172/2155-6156.1000807
Case Report Open Access
J Diabetes Metab, an open access journal
ISSN:2155-6156
Volume 9 • Issue 10 • 1000807

Chiropractic is known as a pain-based health care profession; neck
pain (NP) and back pain are common presentations in chiropractic
practices [19]. However, outside of chiropractic oces, vertebral
subluxations remain an under-diagnosed cause of neck and back pain
[20]. Many chiropractic techniques claim to produce structural
correction of the spine while few are able to support their claims with
scientic clinical evidence. “CBP® technique is a full-spine and posture
rehabilitation approach to correcting poor posture, deviation of
normal spinal alignment and subluxation through incorporating
Mirror Image® exercise, adjustments, and traction procedures” [21-25].
Chiropractic BioPhysics® (CBP®) has various quality scientic
publications supporting reliable correction of spinal and postural
misalignments with correlating neurological, musculoskeletal, and
visceral health improvements [15-19,25-31].
ere has never been a chiropractic study measuring the impact of
correction of spinal misalignment on glycosylated hemoglobin
(HbA1c) and blood-glucose metabolism. is is a prospective case
study with long-term follow-up showing improvements in HbA1c,
blood glucose, mid-back pain, muscle tension, and quality of life
following correction of thoracic hypokyphosis vertebral subluxation
using Chiropractic BioPhysics® Technique. All procedures performed
in this study involving the human participant were in accordance with
the ethical standards of the institutional and/or national research
committee and with the 1964 Helsinki declaration and its later
amendments or comparable ethical standards. Informed consent was
obtained from all individual participants included in the study.
Case and Methods
Clinical features
A 26-year-old male presented to the oce with the primary
complaint of chronic mid-back pain for nine years as well as a medical
diagnosis of T1DM since he was 3 years old. e patient weighed 180
pounds and stood 70 inches tall. e patient reported playing sports
throughout his life and collegiate baseball with no history of trauma.
e patient conrmed a diet consisting of processed foods high in
sugar including donuts, cookies, and soda and was oen seen
consuming these foods when entering the oce. Additionally, the
patient conrmed an active social drinking lifestyle. e patient
reported that he managed his blood-glucose with insulin therapy via
insulin pump. e patient started that he administered a bolus ratio of
10 to 1 at each meal and would administer a basal dose of 6.5 units (U)
each day.
e patient rated his mid-back pain as a 7/10 on the numeric rating
scale (NRS: 0=no pain; 10=maximum pain). Static surface
electromyography (sEMG) was performed using CLA Insight™ Static
sEMG, (Chiropractic Leadership Alliance, Bethany Beach, DE, USA).
Surface EMG has been established as a valid [32,33] and reliable
[34-38] method of measuring amplitude of muscle electrical activity to
determine areas of hypo- or hyperactivity associated with neurological
and musculoskeletal conditions. Static sEMG indicated moderate and
high (severe) elevations in amplitude (tension) of paraspinal muscle
activity throughout the thoracic spinal region (Figure 1). Amplitude
was recorded at elevations as high as 4.4 times more than normal
values at T6 (Table 1).
L Assess
2 (µV)
L Assess
1 (µV)
L Norm
(µV) Site R Norm
(µV)
R Assess
1 (µV)
R Assess
2 (µV)
5.77 4.17 3.8 C1 3.9 5.55 3.94
5.13 4.82 4.4 C3 4.3 6.75 3.83
5.36 4.25 4.2 C5 4.1 3.14 3.95
7.59 4.29 4.8 C7 4.6 5.14 4.56
6.2 11.93 4.9 T1 4.9 5.32 5.31
6.4 21.79 5 T2 5 12.27 4.93
7.31 23.79 6.5 T4 6.4 18.48 5.66
6.66 28.35 8.4 T6 8.2 31.26 5.8
10.6 19.39 9.6 T8 9.5 21.2 6.9
10.74 14.83 10 T10 10 18.65 6.93
11.2 13.8 9.8 T12 9.8 17.17 6.93
12.86 10.21 8.7 L1 8.7 11.67 7.8
11.2 17.54 6.1 L3 6.2 23.97 6.53
9.31 6.37 5.2 L5 5.3 7 6.05
4.95 12.69 4.4 S1 4.4 14.34 4.14
µV: microvolts; Site: Location of the vertebra where paraspinal electrical
amplitude was assessed; L Assess: Left Assessment; R Assess: Right
Assessment
Table 1: sEMG Analyses at Initial Visit versus Aer 36 Visits (7 Weeks).
Using Health and Wellness Score (FLDC, LLC, Cumming, GA,
USA) to administer, score, and analyze the Short Form 36-Question
(SF-36) health survey, the patient scored a 100/100 in physical function
(PF), 25/100 in physical role limitations (PRL), 33.33/100 in emotional
role limitations (ERL), 75/100 in vitality (V), 88/100 in emotional well-
being (EWB), 100/100 in social functioning (SF), 57.5/100 in pain (P!),
35/100 general health (GH), and 50/100 in change in health status
(ΔHS) (Table 2). e scoring of the SF-36 indicates that 0/100
represents the poorest possible result and 100/100 indicates the best
possible result in any quality of life (QoL) domain.
#PF PRL ERL V EWB SF P! GH ΔHS
1 100 25 33.33 75 88 100 57.5 35 50
2 100 75 100 85 92 100 67.5 55 100
3 100 100 100 85 88 100 80 50 50
Citation: Fedorchuk C, Lightstone DF, Comer RD, Weiner MT, McCoy M (2018) Improved Glycosylated Hemoglobin, Hyperglycemia, and Quality
of Life Following Thoracic Hypokyphosis Vertebral Subluxation Correction Using Chiropractic BioPhysics®: A Prospective Case Report.
J Diabetes Metab 9: 807. doi:10.4172/2155-6156.1000807
Page 2 of 10
J Diabetes Metab, an open access journal
ISSN:2155-6156
Volume 9 • Issue 10 • 1000807

PF: Physical Functioning; PRL: Physical Role Limitations; ERL: Emotional Role Limitations; EWB: Emotional Well-Being; V: Vitality; SF: Social Functioning; P!: Pain;
GH: General Health; ΔHS: Change in Health Status
Table 2: Health and Wellness Score SF-36 QoL Analyses at Initial Visit versus Aer 36 Visits (7 Weeks) versus 16 Month Follow-up Assessments.
is 36-Item Health Survey was developed at RAND as part of the Medical Outcomes Study.
Figure 1: Paraspinal sEMG at Initial Visit . White bars indicate
WNL of elevation in amplitude (tension) of paraspinal muscle
electrical activity; Green bars indicate mild elevation in amplitude
(tension) of paraspinal muscle electrical activity; Blue bars indicate
moderate elevation in amplitude (tension) of paraspinal muscle
electrical activity; Red bars indicate high elevation in amplitude
(tension) of paraspinal muscle electrical activity.
Continuous glucose monitor
e patient was using the Dexcom® G4 Platinum Professional
continuous glucose monitoring (CGM) system (Dexcom®, Inc, San
Diego, CA, USA). CGM is FDA-approved and shows blood-glucose
readings every 5 minutes in real time. Dexcom® CGM consists of 3
parts: a small sensor that measures glucose levels is injected just
underneath the skin; a transmitter attached to the top of the sensor
that sends data wirelessly to the receiver; and the receiver that displays
blood-glucose levels and trends. CGM tracks the rate, levels, and
direction of glucose metabolism. During the week prior to chiropractic
care, the CGM recorded a blood glucose average of 175 mg/dL (target
range is 80 to 180 mg/dL) with a standard deviation of + 71 mg/dL.
e CGM reported that the patient’s blood glucose remained in the
high, target, and low ranges 41%, 53%, and 6% of the time, respectively
(Figure 2, Table 3). e CGM also reported hemoglobin A1C (HbA1c,
A1c). HbA1c determines the amount of glucose attached to
hemoglobin, the protein in red blood cells (RBC) that carries oxygen.
Because RBCs live for about 3 months, the HbA1c test reects average
blood glucose levels over the past 3 months. HbA1c is reported as a
percentage; below 5.7% (39 mmol/mol) indicates normal, 5.7-6.4% (39
to 46 mmol/mol) indicates a prediabetes diagnosis, and 6.5% (48
mmol/mol) or more indicated a diabetes diagnosis [39]. Aer the
initial 14 days of using the CGM, it showed the patient’s HbA1c was
7.7% (61 mmol/mol) prior to care (Table 3).
Week
Normal
Range (mg/
dL)
Glucose
Average (mg/
dL)
Standard
Deviation (mg/
dL)
% Time in
High Range
% Time in
Target Range
% Time in
Low Range
Hemo
globin A1C
(%)
Hemo globin A1C
mmol/mol)
C-peptide
(L)
1* 80-180 174 71 39 55 6 7.7 61
2* 80-180 178 72 47 46 7 7.7 61
3# 80-180 157 60 31 63 7
4# 80-180 154 57 33 61 6
5# 80-180 151 46 26 70 4
6# 80-180 159 71 34 54 12 <0.10
7# 80-180 144 66 25 63 12
8# 80-180 144 52 24 66 10
9# 80-180 150 52 24 69 6 6.7 50 <0.10
10* 80-180 166 57 36 59 5
70* 80-180 6.1 43
*: Cells this mark indicate when the patient was not receiving chiropractic care; #: Cells this mark indicate when the patient was receiving chiropractic care; mg/dL:
milligrams per deciliter; HbA1c: Hemoglobin A1c test for percentage of glucose attached to hemoglobin; mmol/mol: Hemoglobin A1c measurement in millimoles per
mole; L: Liter
Table 3: CGM and Blood Test Readings at Initial Visit versus Aer 36 Visits (7 Weeks) versus 16-Month Follow-up Assessments.
Citation: Fedorchuk C, Lightstone DF, Comer RD, Weiner MT, McCoy M (2018) Improved Glycosylated Hemoglobin, Hyperglycemia, and Quality
of Life Following Thoracic Hypokyphosis Vertebral Subluxation Correction Using Chiropractic BioPhysics®: A Prospective Case Report.
J Diabetes Metab 9: 807. doi:10.4172/2155-6156.1000807
Page 3 of 10
J Diabetes Metab, an open access journal
ISSN:2155-6156
Volume 9 • Issue 10 • 1000807

Figure 2: CGM For 7 Days Prior to Chiropractic Care.
Postural and radiographic analysis
Opposing thoracic radiographs were taken and analyzed using
PostureRay® Electronic Medical Records (EMR) Soware (PostureCo,
Inc., Trinity, FL, USA) according to the Harrison Posterior Tangent
method for sagittal spine views [22] and analyses for frontal spine
views. ese examination and analysis methods have established
validity [40-42], reliability and repeatability [43-45] as does posture
[46]. e anterior-to-posterior (AP) thoracic view revealed a spinal
alignment within normal limits (WNL).
Measurement Normal
Values
X-ray 1
Values
X-ray 2
Values
X-ray 3
Values
RRA T2-T3 4.0° 0.1° 3.5° 4.2°
RRA T3-C4 5.0° 3.1° 4.9° 2.0°
RRA T4-T5 6.0° 0.4° 4.0° 4.0°
RRA T5-T6 5.0° 8.0° 5.6° 4.4°
RRA T6-T7 6.0° 5.1° 4.5° 5.8°
RRA T7-T8 6.0° 2.4° 5.5° 4.1°
RRA T8-T9 4.0° -2.5° 3.1° 3.0°
RRA T9-T10 3.0° 1.0° 3.0° 2.4°
RRA T10-T11 3.0° 7.3° 4.0° 5.5°
ARA T6-T9 16.0° 5.0° 13.1° 12.9°
ARA T2-T11 42.0° 24.9 38.1° 35.4°
RRA: Relative rotational angle; the angle measurement of the lines tangent to
the posterior aspect of two adjacent vertebrae listed following RRA; ARA:
Absolute rotational angle; the angle measurement of the lines tangent to the
posterior aspect of two vertebrae at the limits of a spinal region listed following
RRA.
Table 4: PostureRay® EMR Initial Visit versus Aer 36 Visits (7 Weeks)
versus 16 Month Follow-up Radiographic Analyses.
e Lateral thoracic (LT) view (Figure 3) revealed a relative
rotational angle from T8 to T9 (RRA T8-T9) of -2.5° (ideal is 4.0°), an
absolute rotational angle from T5 to T9 (ARA T5-T9) of 11.1° (ideal is
21.0°), and an ARA T2-T11 of 25.7° (normal is 42.0°) (Table 4). ese
analyses indicate a reversed curvature or lordosis at T8-T9 and a
hypokyphosis from T5-T9 and T2-T11.
Figure 3: LT X-ray at Initial Visi. e green line represents the
Normal Spinal Position and expected path of the posterior
longitudinal ligament; e red line represents the patient’s position
known as George’s Line. is is the path of the posterior
longitudinal ligament.
Magnetic resonance imaging (MRI)
An MRI was obtained of the thoracic spine (Figure 4). Multilevel
chronic Schmorl’s nodes, especially from T10 through T12, were noted.
Disc desiccation was greatest at T8-T9 and T10-T11. Disc space
narrowing appeared greatest at T10-T11 and T11-T12. ere was facet
hypertrophy on the right at T9-T10. oracic disc displacement was
most notable at T10-T11 with generalized disc bulging and a very
small central disc herniation.
Citation: Fedorchuk C, Lightstone DF, Comer RD, Weiner MT, McCoy M (2018) Improved Glycosylated Hemoglobin, Hyperglycemia, and Quality
of Life Following Thoracic Hypokyphosis Vertebral Subluxation Correction Using Chiropractic BioPhysics®: A Prospective Case Report.
J Diabetes Metab 9: 807. doi:10.4172/2155-6156.1000807
Page 4 of 10
J Diabetes Metab, an open access journal
ISSN:2155-6156
Volume 9 • Issue 10 • 1000807

Figure 4: LT View of MRI at Initial Visit.
Intervention
e patient was seen for 36 visits over 7 weeks per CBP® technique
protocols using Mirror Image® exercises, adjustments, and traction to
correct the thoracic lordosis and overall hypokyphosis. e patient was
not being treated for T1DM. e patient was not advised to alter any
treatments or therapies for his T1DM. e patient was being treated
for vertebral subluxation and spinal misalignment and dysfunction.
Chiropractic care consisted of full-spine chiropractic adjustments and
CBP® Mirror Image® drop table adjustments, exercises, and traction at
each visit. Using Mirror Image® protocol, the patient was placed into an
over-corrected posture for adjustments, exercises, and traction to
facilitate spinal alignment and posture correction. e hand-held
Impulse® adjusting instrument (Neuromechanical Innovations,
Chandler, AZ, USA) was used to apply spinal and paraspinal
mechanical impulses [47]. e Impulse® adjusting instrument delivers
a consistent programmed mechanical thrust to stimulate
mechanoreceptors and proprioceptors to relay the position of the body
to the brain to retrain the patient’s central nervous system (CNS) to
adapt to normal posture according to the Harrison Spinal Model.
Twenty repetitions of Mirror Image® thoracic exion correction
exercises were performed at each appointment. Mirror Image®
exercises “attempt to re-train the physiologic adaptations of the so
tissues of the spine by frequently stressing these tissues favoring the
optimum loading position balance [48]”. e Erickson Traction
Fulcrum (Circular Traction Supply, Inc., Huntington Beach, CA, USA)
and CBP® Mirror Image® Blocks (CBP Seminars, Inc., Meridian, ID,
USA) were used for thoracic exion traction at 15 minutes per session
with one session per appointment. Deformation forces over a long
period of time counter habituated abnormal posture [15-18]. e
fulcrum and blocks are used to apply a counterforce against the
direction of spinal misalignments. Gravity forces the body against the
fulcrum and blocks and additional straps aid in additional force
against the blocks to increase the intensity of the counterforce as the
patient’s tolerance increases.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Average Blood Glucose
Level (mg/dL) 130.6# 164.4* 149.9# 146.4# 149.7# 149* 161.5*
*: Cells this color indicate when the patient was not receiving chiropractic care; #: Cells this color indicate when the patient was receiving chiropractic care; mg/dL:
milligrams per decilitre.
Table 5: CGM Average Blood Glucose Levels per day During 7 weeks of Chiropractic Care.
Outcomes aer 7 weeks of chiropractic care
e patient stated that he maintained his lifestyle throughout
chiropractic care. e patient was reassessed aer the 36 visits. LT x-
ray (Figure 5) analysis (Table 4) aer the 36 visits revealed
improvements in RRA T8-T9 from -2.5° to 3.1° (ideal is 4.0°), ARA
T6-T9 from 5.0° to 13.1° (ideal is 16.0°), and ARA T2-T11 from 24.9°
to 38.1° (normal is 42.0°). e patient reported that his mid-back pain
was reduced from NRS 7/10 to 4/10. Static sEMG was performed again
and the patient showed improvements in amplitudes of paraspinal
muscle electrical activity from severe readings to mild and mostly
WNL readings (Figure 6, Table 1). On the SF-36, the patient showed
maintenance or improvement in QoL domains (Table 2).
During the last week of chiropractic care, the CGM recorded an
improved blood glucose average of 142 mg/dL with a standard
deviation of + 52 mg/dL. e CGM reported that the patient’s blood
glucose remained in the high, target, and low ranges 22%, 67%, and
11% of the time, respectively (Figure 7, Table 3) and the patient’s
HbA1c improved to 6.7% (50 mmol/mol) (Table 3). Interesting to note,
the CGM showed an average decrease in blood glucose of 81.6 mg/dL
at the onset of each Mirror Image® traction session throughout care
with an average lasting time of approximately 3 hours before
increasing again. Additionally, during the 7 weeks of chiropractic care,
the CGM showed a marked decrease in average blood glucose of 14.5
to 33.8 mg/dL on the days the patient received chiropractic care versus
the days he did not (Table 5). e patient also reported that he reduced
his basal insulin dosage from 6.5U to 3U during week 4 of care. He
stated that he was able to keep that dosage throughout the remainder
of his care. When the patient was released from chiropractic care aer
the 7 weeks, he discontinued the use of the CGM.
Citation: Fedorchuk C, Lightstone DF, Comer RD, Weiner MT, McCoy M (2018) Improved Glycosylated Hemoglobin, Hyperglycemia, and Quality
of Life Following Thoracic Hypokyphosis Vertebral Subluxation Correction Using Chiropractic BioPhysics®: A Prospective Case Report.
J Diabetes Metab 9: 807. doi:10.4172/2155-6156.1000807
Page 5 of 10
J Diabetes Metab, an open access journal
ISSN:2155-6156
Volume 9 • Issue 10 • 1000807

Figure 5: LT X-ray aer 36 Visits (7 Weeks). e green line
represents the Normal Spinal Position and expected path of the
posterior longitudinal ligament; e red line represents the patient’s
position known as George’s Line. is is the path of the posterior
longitudinal ligament.
Figure 6: CGM For Last 7 Days of Chiropractic Care.
Figure 7: Paraspinal sEMG aer 36 Visits. White bars indicate WNL
of elevation in amplitude (tension) of paraspinal muscle electrical
activity; Green bars indicate mild elevation in amplitude (tension)
of paraspinal muscle electrical activity; Blue bars indicate moderate
elevation in amplitude (tension) of paraspinal muscle electrical
activity; Red bars indicate high elevation in amplitude (tension) of
paraspinal muscle electrical activity.
Outcomes at long-term follow-up assessment 16 Months
following chiropractic care
e patient was reassessed 16 months following chiropractic care.
e patient stated that he did not change lifestyle habits from prior to
his chiropractic care through long-term follow-up assessment. LT x-
ray (Figure 8) analysis (Table 4) 16 months aer chiropractic care
revealed maintained improvements in RRA T8-T9 from 3.1° to 3.0°
(ideal is 4.0°), ARA T6-T9 from 13.1° to 12.9° (ideal is 16.0°), and ARA
T2-T11 from 38.1° to 35.4° (normal is 42.0°). e patient reported that
his mid-back pain maintained a reduction from NRS 4/10 to 4/10. On
the SF-36, the patient showed maintenance or improvement in QoL
domains (Table 2). A blood test showed the patient’s HbA1c further
decreased to 6.1% (43 mmol/mol) (Table 3). e patient also reported
that he was able to maintain the reduced basal insulin dosage of 3U at
16-month follow up.
Citation: Fedorchuk C, Lightstone DF, Comer RD, Weiner MT, McCoy M (2018) Improved Glycosylated Hemoglobin, Hyperglycemia, and Quality
of Life Following Thoracic Hypokyphosis Vertebral Subluxation Correction Using Chiropractic BioPhysics®: A Prospective Case Report.
J Diabetes Metab 9: 807. doi:10.4172/2155-6156.1000807
Page 6 of 10
J Diabetes Metab, an open access journal
ISSN:2155-6156
Volume 9 • Issue 10 • 1000807

Figure 8: LT X-ray at 16-Month Follow-up. e green line
represents the Normal Spinal Position and expected path of the
posterior longitudinal ligament; the red line represents the patient’s
position known as George’s Line. is is the path of the posterior
longitudinal ligament.
Discussion
is report documents the successful outcomes in a 26-year-old
patient with mid-back pain and T1DM as well as unhealthy spinal
alignment and posture and paraspinal muscle tension. Improvements
in symptoms were achieved following the correction of thoracic spinal
alignment using CBP® technique and the application of Mirror Image®
chiropractic adjustments, spinal exercises, and spinal traction using
CBP® Mirror Image® Blocks.
Certain circumstances and concurrences need to be highlighted
within this report. e patient did not alter his lifestyle throughout or
following care. It is remarkable that he continued to consume
processed foods high in sugar and still yielded the extraordinary health
improvements documented. e patient stated that chiropractic care
was the only change in his everyday routine. During and following
correction of the thoracic spinal alignment, the patient yielded
signicant improvements in blood glucose levels and HbA1c (Table 3).
Biomechanics, neurology, and dysautonomia
An action potential along the spinal cord and nerves is accompanied
by shortening and swelling of the nerve [49]. Sagittal spinal deformities
and vertebral subluxations apply abnormal tensile forces in the brain
stem, cranial nerves 5-12, spinal cord, and nerve roots. Increased
tension resists shortening and swelling of nerve bers that accompany
an action potential. is tension can give rise to local and distant signs
and symptoms including neuralgias, spasticity, dizziness, bladder
dysfunction, cervical and lumbar spondylosis, disk hernias, trauma to
the spinal cord, and autoimmune disorders [15-18,27-29,50].
Additionally, according to Uchida et. al, “adequate correction of local
sagittal alignment may help to maximize the chance of neurological
improvement [48]”. is serves as a proposed mechanism for the
source of this patient’s health improvements following sagittal thoracic
spinal correction.
Presynaptic sympathetic nerves that innervate the pancreas arise
from cell bodies of the intermediolateral (IML) nucleus of the spinal
cord located at spinal cord segments T6 through T9. As such, T6
through T9 sagittal alignment was noted in this report as well as any
remarkable ndings in that anatomy including the reversed RRA T8-
T9. ese nerve bers travel via “spinal nerves, anterior rami, and
white communicating branches to the sympathetic trunks, continue as
components of abdominopelvic splanchnic nerves [and] pass to
prevertebral ganglia. Aer synapsing with the ganglia, the post-
synaptic sympathetic nerves travel to the [pancreas] conveying
sympathetic innervation [51]”.
Various studies have investigated the relationship between spinal
dysfunction and increased sympathetic tone [52-54], which has been
linked with immune dysfunction and reduced health [55,56]. In a
study of 50 cadavers with 139 diseased organs, Windsor found that the
100% of the diseased organs belonged to the same sympathetic
segment as an aected vertebra found to be out of normal spinal
alignment [55]. e results of a study of 12 men suggests that
chiropractic care aects regional glucose metabolism related to
sympathetic relaxation [inhibition] and pain reduction [57]. “e
sympathetic nervous system (SNS) plays a signicant role in metabolic
function and coordination of glucose homeostasis. In the pancreas,
sympathetic activation inhibits insulin release and increases glucagon
secretion [58]”.
In this case, x-rays showed that the patient’s T6 through T9 spinal
alignment was extended in neutral, standing posture. CGM readings
during thoracic exion traction showed that blood glucose metabolism
was markedly increased as a result.
Initial x-ray and MRI ndings conrm the degenerative eects of
loss of sagittal curvature in the spine which serve as shock absorbers.
With decreased shock absorption in the thoracic spine, the functional
spinal unit is subjected to increased force. As such, degeneration
occurs consistent with Wol’s law of bone adaptation and Davis’ Law
of so tissue adaptation. “With mal-alignment in neutral posture, static
and especially dynamic function from this mal-alignment dictates
altered stress/strain relationships of associated spinal structures,
including the bones, intervertebral discs, facet joints,
musculotendinous tissues, ligamentous tissues, and neural elements
[22]”.
Reassessment x-rays conrmed that the patient’s T6 through T9
spinal alignment had been corrected and blood testing showed that the
HbA1c improved during and following care and continued to improve
while correction of the thoracic spine was maintained. is is
particularly important as the Diabetes Control and Complications
Trial (DCCT) shows that a person’s ability to maintain glycemic
control signicantly reduces his risk of complications and
comorbidities associated with T1DM and that “achieving reduced
HbA1c concentrations, continue to have greater protection against
development or progression of complications [12]”. e continued
improvement in HbA1c may be a part of the body’s natural healing
process. A fractured bone has not fully healed neither upon setting of
the bone nor casting of the bone nor removal of the cast. Rather, the
bone continues to heal well beyond removal of the cast.
Strengths and Limitations
One limitation to report is that this is a case study (n=1). However,
the prospective design of the case study paired with a long-term
follow-up assessment provide added strength to the case. As a
Citation: Fedorchuk C, Lightstone DF, Comer RD, Weiner MT, McCoy M (2018) Improved Glycosylated Hemoglobin, Hyperglycemia, and Quality
of Life Following Thoracic Hypokyphosis Vertebral Subluxation Correction Using Chiropractic BioPhysics®: A Prospective Case Report.
J Diabetes Metab 9: 807. doi:10.4172/2155-6156.1000807
Page 7 of 10
J Diabetes Metab, an open access journal
ISSN:2155-6156
Volume 9 • Issue 10 • 1000807

prospective case study, it does not lend itself to selection bias. e 16-
month follow-up aer cessation of chiropractic care helps to determine
the lasting eectiveness of the care administered. Another limitation is
that various interventions were applied to the patient. As such, it is
uncertain which intervention or combination of interventions had the
positive eect on the patient’s health measures. And, while spinal
manipulation and exercise have not been shown to reliably correct
spinal alignment [25,59-61], there may be a reliable combination of
therapies within permutations of Mirror Image® exercises, adjustments,
and traction [15-18].
Improvement of HbA1c is clinically signicant. e DCCT and the
United Kingdom (UK) Prospective Diabetes Study have found that any
interventions done to improve the HbA1c levels in diabetics directly
decreases the risk of complications related to T1DM [62,63].
Conclusion
is case adds more evidence to claims that thoracic spinal
alignment may also improve paraspinal muscle tension, QoL, and mid-
back pain. As thoracic spinal alignment improved, so too did the listed
health measures. is case also suggests, for the rst time, that thoracic
spinal alignment may be related to blood glucose metabolism and that
correction thereof may inuence blood glucose metabolism as
represented by HbA1c and CGM blood glucose measurements. Spinal
analysis and care may benet people with T1DM in terms of glycemic
control and aid in screening for T1DM early detection. Diabetes
researchers have emphasized the need to perfect the prediction model
for T1DM “and to develop eective and safe interventions that reverse
the condition either in its preclinical or early clinical phase [12]”.
Additionally, researchers are looking for novel treatment strategies to
achieve normoglycaemia. “Although insulin analogues and insulin
pumps help more physiological insulin replacement approaches to be
developed, they remain imperfect because of factors other than insulin
that aect glycaemia [12]”. Randomized clinical controlled trials
involving measuring thoracic spinal alignment and HbA1c and CGM
blood glucose measurements of a large population of people with
T1DM should be conducted. is case report will serve as a motivation
for higher levels of evidence from which correlations and causations
regarding the eects that chiropractic spinal corrective care might have
on blood glucose metabolism can be made.
Acknowledgements
e authors would like to acknowledge Chiropractic BioPhysics®
NonProt (a spine research foundation in Eagle, ID, USA) for their
support and Dr. Kwon for presenting this case at the 2016 International
Research and Philosophy Symposium (IRAPS) (Sherman College of
Chiropractic, Spartanburg, SC, USA).
Funding
Funding for monitoring equipment and laboratory costs for the
participant in this case was provided by the Foundation for Vertebral
Subluxation (FVS, Kennesaw, GA, USA). Sponsorship for this study
and article processing charges were funded by the Institute for Spinal
Health and Performance (ISHP, Cumming, GA, USA).
Compliance with Ethical Standards
Disclosure of potential conicts of interest
Drs. Curtis Fedorchuk, Douglas F. Lightstone, Robert D. Comer, and
Michael T. Weiner are chiropractors who practice using Chiropractic
BioPhysics® protocols. Drs. Curtis Fedorchuk and Douglas F.
Lightstone are ocers of the ISHP which funded this paper. Dr. Robert
D. Comer is a member of the ISHP. Drs. Curtis Fedorchuk and
Matthew McCoy are ocers of the FVS which funded this paper. Dr.
Douglas F. Lightstone has a research fellowship through the FVS.
Research involving human participants and/or animals
All procedures performed in this study involving the human
participant were in accordance with the ethical standards of the
institutional and/or national research committee and with the 1964
Helsinki declaration and its later amendments or comparable ethical
standards. Informed consent was obtained from all individual
participants included in the study. Additional informed consent was
obtained from all individual participants for whom identifying
information is included in this article. e participant was a patient in
a private chiropractic practice and provided informed consent for
publication of the results of his case.
Informed consent
is study was reviewed for Human Subjects Protection and
approved by the Independent Review Board of the Foundation for
Vertebral Subluxation. e participant was a patient in a private
chiropractic practice and provided informed consent for publication of
the results of his case.
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ISSN:2155-6156
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Citation: Fedorchuk C, Lightstone DF, Comer RD, Weiner MT, McCoy M (2018) Improved Glycosylated Hemoglobin, Hyperglycemia, and Quality
of Life Following Thoracic Hypokyphosis Vertebral Subluxation Correction Using Chiropractic BioPhysics®: A Prospective Case Report.
J Diabetes Metab 9: 807. doi:10.4172/2155-6156.1000807
Page 10 of 10
J Diabetes Metab, an open access journal
ISSN:2155-6156
Volume 9 • Issue 10 • 1000807