How to Integrate?
Caring for individuals with diabetes is complicated, even without considering alternative therapies. Prescribing medication is the easiest component of care, but should not become the main focus of treatment, as it has for so many conditions in the U.S. health care system. Tossing out the medications and substituting herbs and supplements is no better and, in the case of diabetes, may be dangerous.
A truly integrative approach will work with the individual to help them make positive changes. This will likely occur slowly over many months to years and require frequent contact with the health care system. It will involve high quality, patient centered care that takes into account the patient's wishes and goals.
The overall goal is a person who requires less pharmacotherapy and has significant improvement in disease state and quality of life. Many of the interventions discussed here effect aspects of health and wellness beyond the specifics of blood glucose control.
When I approach diabetes with patients about blood glucose control, I emphasize the need to get their sugars down fairly quickly. I almost always recommend pharmacotherapy in addition to nutrition, physical activity, herbs, supplements and a variety of mind-body techniques that we may discuss and try. We can then wean medications as their sugars, blood pressure, etc. allow.
Remember our patient, JL?
JL is a 52-year-old woman who was diagnosed with diabetes two years ago. She has an extensive family history of diabetes and has seen a number of relatives die from complications of the disease. She has struggled with weight for a number of years and cannot find time to exercise. She works full time and has three teenagers still at home. She is hesitant to take medications and is worried about side effects. Her cousin has recommended that she take some supplements that she heard will cure diabetes without medication. She comes in to see you because she is worried about her health and wants to know where to start.
After a detailed history and assessment of her motivations, I would work with her to set specific goals – both short- and long-term. I would focus on nutrition and recommend that she work with a dietician to get started. I would also strongly suggest that she enroll in one or more of the Preventive Cardiology programs at the University of Michigan. Finding a form of physical activity that she can commit to is essential, as well.
We could go over the supplements that her cousin told her about and review any relevant literature. I would recommend that she start with a low dose of metformin and titrate it up slowly over the next few weeks. I would also recommend starting with 400mg of Magnesium glycinate, 200mg of chromium piccolinate and a multivitamin. I would request testing of her cholesterol level, liver function and 25-OH Vitamin D level. I would have her check her blood sugars periodically and follow up within a few weeks at the clinic.
This case analysis provides you with one example of an integrative approach to treatment of diabetes although many other options are available to you as physicians.
Always remember that the desires of the patient are at the heart of all successful treatment planning.