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AADE Quick Guide to Medications. Rev. ed. Chicago, IL: American Association of Diabetes Educators. 2008. 39 p.
Nearly everyone with diabetes will require medications, from oral glucose-lowering drugs to insulin, or both, to reach blood glucose goals. In addition to these medications, drug therapies for people with diabetes often include other agents to treat the various associated comorbid conditions or complications of diabetes. This booklet is designed to help health care professionals and educators understand the total range of therapies available for comprehensive diabetes care, not just those used to improve glycemic control. The booklet includes seven sections: glucose-lowering agents, insulin, common agents for blood pressure control, common agents for cholesterol control, recommended priorities and suggested drug therapy for people with diabetes and dyslipidemia, miscellaneous topics, and a resource list. Most of the information is provided in chart form. Specific topics and drugs covered include sulfonylureas, biguanides, thiazolidinediones, alpha-glucosidase inhibitors, incretins, amylin analog, DPP-IV inhibitors, bile acid sequestrants, fixed-dose combinations, guidelines for mixing insulin and prefilling syringes, starting insulin, ACE inhibitors, ARBs, diuretics, beta-blockers, calcium channel blockers, statins, fibric acid derivatives, absorption inhibitors, bile acid sequestrants, nicotinic acid, omega-3 fatty acids, drug-disease interactions, drug-drug interactions, the treatment of hypoglycemic emergencies, and complementary and alternative medicine (CAM). The pocket-sized booklet is spiral bound for easy use. 12 references.
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Botanical and Nonbotanical CAM Supplements That May Treat Complications of Diabetes. IN: Shane-McWhorter, L. Complementary and Alternative Medicine (CAM) Supplement Use in People With Diabetes: A Clinician's Guide. Alexandria, VA: American Diabetes Association. 2007. pp 111-156.
This chapter about botanical and nonbotanical supplements used for the complications of diabetes is from a book that informs health care professionals about some of the complementary and alternative medicine (CAM) supplements that are commonly used by people with diabetes. The book includes in-depth descriptions of botanical and nonbotanical CAM supplements to treat diabetes, tables summarizing supplements and therapies, a review of the clinical studies and chemical constituents for each supplement, and advice for diabetes clinicians. In this chapter, the author discusses the supplements that may be used by patients in the hope of preventing or treating diabetes-related complications––alpha-lipoic acid, vitamin E, gamma-linolenic acid, ginkgo, fish oil, policosanal, garlic, guggul, red yeast rice, and St. John’s wort. For each supplement, the author provides an introduction, a discussion of the chemical constituents and mechanism of action, a description of the adverse effects and drug interactions, a brief review of any clinical studies available, and a summary. A table collates the information in this section. 1 table.
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Botanical CAM Supplements to Treat Diabetes. IN: Shane-McWhorter, L. Complementary And Alternative Medicine (CAM) Supplement Use in People With Diabetes: A Clinician's Guide. Alexandria, VA: American Diabetes Association. 2007. pp 15-86.
This chapter about botanical supplements is from a book that informs health care professionals about some of the complementary and alternative medicine (CAM) supplements commonly used by people with diabetes. The book includes in-depth descriptions of botanical and nonbotanical CAM supplements to treat diabetes, tables summarizing supplements and therapies, a review of the clinical studies and chemical constituents for each supplement, and advice for diabetes clinicians. The botanical CAM supplements covered in this chapter are cinnamon, gymnema, fenugreek, bitter melon, Asian ginseng, American ginseng, nopal, aloe, banaba, caiapo, ivy gourd, holy basil, vijayasar, jambolan, blond psyllium, glucomannan, guar gum, stevia, pine bark extract, tea, bilberry, and milk thistle. For each supplement, the author provides an introduction, a discussion of the chemical constituents and mechanism of action, a description of the adverse effects and drug interactions, a brief review of any clinical studies available, and a summary. A table collates the information in this section. 1 table.
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Plants Used in the Treatment of Diabetes. IN: Soumyanath, A., ed. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 19-82.
This lengthy chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this chapter, the authors review the plants used in the treatment of diabetes. An introductory section considers the background of plant use for diabetes. The bulk of the chapter focuses on selection of species, presenting a review of the literature from 1995 to 2005 in chart format. The authors used five criteria to prioritize the selection of species: traditional use in one or more countries, experimentally determined hypoglycemic activity, lack of detailed information on hypoglycemic constituents, experimental evidence for low toxicity, and botanical abundance. The detailed chart of species lists order/family, species, distribution and area in which traditionally used, the plant part used, and comments about activity. A final section offers a discussion of future directions for research into botanicals for treating diabetes. 1 figure. 1 table. 311 references.
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Preclinical and Clinical Methods for Evaluating Antidiabetic Activity of Plants. IN: Soumyanath, A., ed. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 83-98.
This chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this chapter, the authors review the preclinical and clinical methods used for evaluating the antidiabetic activity of plants. They discuss animal models, insulin-dependent and noninsulin-dependent models, models of diabetic complications, tests for antidiabetic activity, the clinical evaluation of antidiabetic plants through clinical trials, and ethical issues. They conclude that, at present, the rigorous procedures for the evaluation of conventional antidiabetes medications have rarely been applied to the testing of raw plant materials and the unrefined principles used as traditional treatments for diabetes. Thus, the less intensive evaluation of plant medicines thus far precludes accurate comparisons between conventional and traditional antidiabetes therapies. 2 figures. 5 tables. 30 references.
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Closing Comments and Advice for Clinicians. IN: Shane-McWhorter, L. Complementary And Alternative Medicine (CAM) Supplement Use in People With Diabetes: A Clinician's Guide. Alexandria, VA: American Diabetes Association. 2007. pp 161-166.
This chapter is the concluding entry in a book that informs health care professionals about some of the complementary and alternative medicine (CAM) supplements that are commonly used by people with diabetes. The book includes in-depth descriptions of botanical and nonbotanical CAM supplements to treat diabetes, tables summarizing supplements and therapies, a review of the clinical studies and chemical constituents for each supplement, and advice for diabetes clinicians. In this chapter, the author offers closing comments and advice for clinicians, who may be asked to serve as a resource for diabetes patients who are interested in using CAM therapies. The author advocates an open-minded, yet evidence-based approach. Readers are reminded that patients with diabetes who are considering use of CAM supplements are likely to be active participants in their own health care and motivated to find and use effective treatments, whether alternative or traditional. A discussion of regulation and manufacturing issues is important to discourage the use of dangerous or ineffective products. Readers and their patients are referred to the Food and Drug Administration (FDA) website that provides information for supplement users (www.cfsan.fda.gov). The chapter includes a case example of a postmenopausal woman with diabetes who has retinopathy and peripheral neuropathy who asks her clinician about using CAM supplements.
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Complementary and Alternative Medicine (CAM) Supplement Use in People with Diabetes: A Clinician's Guide. Alexandria, VA: American Diabetes Association. 2007. 212 p.
This book informs health care professionals about some of the complementary and alternative medicine (CAM) supplements that are commonly used by people with diabetes. The book includes in-depth descriptions of botanical and nonbotanical CAM supplements to treat diabetes, tables summarizing supplements and therapies, a review of the clinical studies and chemical constituents for each supplement, and advice for diabetes clinicians. The botanical CAM supplements covered include cinnamon, gymnema, fenugreek, bitter melon, Asian ginseng, American ginseng, nopal, aloe, banaba, caiapo, ivy gourd, holy basil, vijayasar, jambolan, blond psyllium, glucomannan, guar gum, stevia, pine bark extract, tea, bilberry, and milk thistle. Nonbotanical CAM supplements used to treat diabetes are discussed, including chromium, vanadium, nicotinamide, magnesium, and coenzyme Q10. The book reviews botanical and nonbotanical CAM supplements that may treat complications of diabetes, including alpha-lipoic acid, vitamin E, gamma-linolenic acid, ginkgo, fish oil, policosanal, garlic, guggul, red yeast rice, and St. John's wort. The book concludes with a list of references, a bibliography and list of useful websites for clinicians, and a subject index. 3 tables. 378 references.
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Complimentary and Alternative Medicine Use in Diabetes. Practical Diabetology. 26(2): 24-26. June 2007.
This article reviews some complementary and alternative medicine (CAM) approaches used to treat diabetes. The author notes that many individuals with chronic diseases such as diabetes seek CAMs to manage their illness. The author discusses five of the most common supplements and treatment modalities used by people with diabetes: chromium picolinate, gymnema, fenugreek, garlic, and meditation, yoga, and prayer. The author cautions that although many of the CAM modalities mentioned have been researched, few studies have shown scientific evidence of effectiveness or have explored the potential side effects of CAMs. Health care providers are encouraged to keep an open communication with patients, to help patients think objectively about any CAM approach they are considering. An open and inviting health care environment can help patients feel comfortable revealing detailed information about their health and all medications they are taking, both prescribed and non-prescribed. 1 table. 8 references.
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Hypnotherapy: A Complementary Therapy with Broad Application. Diabetes Self-Management. 21(5): 15-18. September-October 2004.
Hypnotherapy is a treatment method that makes use of the state of focused attention known as hypnosis. This article describes hypnotherapy and its use as a complementary therapy for a variety of medical and lifestyle issues. In the altered state of consciousness of hypnosis, people may experience lower blood pressure, a decreased heart rate, and slower brain-wave activity; in this state of deep relaxation people find themselves more susceptible to suggestion. The author describes how several techniques may be used with hypnosis to help bring about changes in a person's thinking and behavioral patterns: suggestion, guided imagery, and ideomotor signaling. The author then discusses the possible uses of hypnotherapy for people with diabetes and outlines what one can expect in a hypnotherapy session. The author concludes by reminding readers that the willingness to change is necessary for hypnotherapy to be an effective behavior modification technique. One sidebar lists and briefly describes books and web sites that contain more information about hypnosis.
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Improving Blood Flow to the Feet: The Power of Relaxation and Biofeedback. Diabetes Self-Management. 21(5): 28-31. September-October 2004.
Many people with diabetes experience discomfort in their legs and feet, with symptoms such as cramping, numbness, tingling, and pain. The cause of these symptoms may be poor circulation (peripheral arterial disease or PAD), nerve damage (neuropathy), or both. This article considers the role of relaxation and biofeedback in improving blood flow to the feet, particularly in people with diabetes. The author first describes the most common form of PAD and the development of diabetic neuropathy, then discusses the treatment options, which usually include drug therapy. The author then introduces a simple and inexpensive complementary therapy called WarmFeet. WarmFeet is a guided relaxation and biofeedback method that can increase blood flow to the periphery of the body and relieve pain. The WarmFeet technique includes three components: relaxation, induced by listening to an audiotape program; visualization; and assisted thermal biofeedback (measuring skin temperature at a specific site before and after the relaxation process). The author notes that regular practice of the WarmFeet technique also provides side benefits such as lower blood pressure and improved coping skills, both quite useful for people with diabetes. One section describes research studies that were conducted to test the effectiveness of this biofeedback-assisted relaxation technique.
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Introduction to Complementary And Alternative Medicine (CAM) Supplement Use in People With Diabetes: A Clinician's Guide. IN: Shane-McWhorter, L. Complementary And Alternative Medicine (CAM) Supplement Use in People With Diabetes: A Clinician's Guide. Alexandria, VA: American Diabetes Association. 2007. pp 1-14.
This introductory section is from a handbook that informs health care professionals about some of the complementary and alternative medicine (CAM) supplements that are commonly used by people with diabetes. The book includes in-depth descriptions of botanical and nonbotanical CAM supplements to treat diabetes, tables summarizing supplements and therapies, a review of the clinical studies and chemical constituents for each supplement, and advice for diabetes clinicians. The introduction helps readers define CAM compared with dietary supplements and outlines reasons for concern regarding CAM supplement use, the epidemiology of CAM supplement use, regulation of CAM supplements, testing CAM supplements, evaluating claims from manufacturers of dietary supplements, and the CAM supplements used for diabetes and its complications. Specific concerns about the use of CAM supplements discussed include potential drug interaction, untoward reactions during surgery, product variability, the lack of standardization, misidentification and mislabeling, product labeling, clinical studies of CAM supplements, and cost issues. Readers are referred to the websites of the Food and Drug Administration (FDA) Center for Food Safety and Applied Nutrition (www.cfsan.fda.gov) for more information for themselves and their patients.
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Nonbotanical CAM Supplements to Treat Diabetes. IN: Shane-McWhorter, L. Complementary And Alternative Medicine (CAM) Supplement Use in People With Diabetes: A Clinician's Guide. Alexandria, VA: American Diabetes Association. 2007. pp 87-110.
This chapter about nonbotanical supplements is from a book that informs health care professionals about some of the complementary and alternative medicine (CAM) supplements commonly used by people with diabetes. The book includes in-depth descriptions of botanical and nonbotanical CAM supplements to treat diabetes, tables summarizing supplements and therapies, a review of the clinical studies and chemical constituents for each supplement, and advice for diabetes clinicians. The nonbotanical CAM supplements discussed are chromium, vanadium, nicotinamide, magnesium, and coenzyme Q10. For each supplement, the author provides an introduction, a discussion of the chemical constituents and mechanism of action, a description of the adverse effects and drug interactions, a brief review of any clinical studies available, and a summary. A table collates the information in this section. 1 table.
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Other CAM Products. IN: Shane-McWhorter, L. Complementary and Alternative Medicine (CAM) Supplement Use in People With Diabetes: A Clinician's Guide. Alexandria, VA: American Diabetes Association. 2007. pp 157-160.
This chapter about miscellaneous supplements is from a book that informs health care professionals about some of the complementary and alternative medicine (CAM) supplements that are commonly used by people with diabetes. The book includes in-depth descriptions of botanical and nonbotanical CAM supplements to treat diabetes, tables summarizing supplements and therapies, a review of the clinical studies and chemical constituents for each supplement, and advice for diabetes clinicians. In this chapter, the author briefly discusses the supplements that may be used by patients in the hope of preventing or treating diabetes and its complications and that were not covered in the other chapters. The author mentions a few products: L-carnitine, dark chocolate, and hoodia. Readers are reminded American Diabetes Association (ADA) statement about unproven therapies, which acknowledges the widespread use of alternative therapies and the need for cautious evaluation of these products.
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Maggot Therapy for Treating Diabetic Foot Ulcers Unresponsive to Conventional Therapy. Diabetes Care. 26(2): 446-451. February 2003.
This article reports on a study undertaken to assess the efficacy of maggot therapy for treating foot and leg ulcers in diabetes patients failing conventional therapy. The author studied a cohort of 18 patients with 20 nonhealing ulcers, six wounds were treated with conventional therapy, sex with maggot therapy, and eight with conventional therapy first, then maggot therapy. Repeated measures analysis indicated no significant change in necrotic tissue, except when factoring for treatment. During the first 14 days of conventional therapy, there was no significant debridement of necrotic tissue; during the same period with maggot therapy, necrotic tissue decreased by an average of 4.1 square centimeters. After 5 weeks of therapy, conventionally treated wounds were still covered with necrotic tissue over 33 percent of their surface, whereas after only 4 weeks of therapy maggot-treated wounds were completed debrided. Maggot therapy was also associated with hastened growth of granulation tissue and greater wound healing rates. The author concludes that maggot therapy was more effective and efficient in debriding nonhealing foot and leg ulcers in male veterans with diabetes than was continued conventional care. 3 figures. 2 tables. 26 references.
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Herbs and Supplements: Here's What You Need to Know to be a Wiser Consumer of Alternative Therapies. Diabetes Forecast. 55(10): 95-97. October 2002.
Dietary supplements, such as herbs, amino acids, botanical extracts, vitamins, and minerals are increasingly popular, including among people with diabetes. This article outlines strategies with which readers can be wise consumers of these alternative therapies. The author reviews the safety issues of prescription drugs versus alternative therapies, then discusses interactions between drugs and herbs. One sidebar lists dangerous herbs and supplements that people with diabetes should never take: chaparral, coltsfoot, comfrey, ephedrine (ephedra or ma huang), germander, jin bu huan, lobelia, phenylalanine, sassafras, L-tryptophan, and yohimbe. The article concludes with a list of suggestions for safe supplement use. 1 figure.
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Antidiabetic Plants in Mexico and Central America. IN: Soumyanath, A., ed. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 179-194.
This chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this chapter, the authors discuss antidiabetic plants in Mexico and Central America. A lengthy chart lists the 175 antidiabetic plants more used empirically for diabetes control in Mexico and Central America; 23 species are used in two or more countries of the region. For each plant listed, the table includes information about the botanical family, scientific name, most used popular name in Mexico or Central America, part used, manner of preparation, and number of bibliographic references indicating that each plant has potential antidiabetic effects. The authors note that people in this region likely use more than 300 different species, not just the 175 species listed in the chapter’s table. For more than 80 of these plants, experimental studies have been carried out and hypoglycemic effects have been detected in about 50 percent of the plants. The authors conclude by calling for further experiments to develop new medicines and phytomedicines to treat diabetes and to reduce the economic and social cost of medicine for this condition and its complications. 1 table. 56 references.
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Antidiabetic Plants in North Africa and the Middle East. IN: Soumyanath, A., ed. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 221-242.
This chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this chapter, the authors describe antidiabetic plants of North Africa and the Middle East. The authors note that these regions have a rich traditional antidiabetic pharmacopoeia that includes over 130 plant species. They summarize these drugs in a table. The authors selected 12 of these plants on the basis of citation frequency in book chapters and review articles. Each of these plants has been the object of three or more published scientific studies. The authors summarize these 12 plants in alphabetical order. They conclude that much research is still needed to ascertain the antidiabetic potential of these plants, to determine their active principles, and to elucidate their modes of action. Of all the plants described here, fenugreek, momordica, onion, and garlic appear to be the safest and have the most scientific evidence supporting their antidiabetic potential. 1 table. 204 references.
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Antidiabetic Plants in the Caribbean. IN: Soumyanath, A., ed. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 195-202.
This chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this chapter, the authors describe antidiabetic plants in the Caribbean. Traditional plant remedies in the Caribbean are known as bushteas or bushmedicines, and they are particularly common in communities with limited access to formal health care. The authors caution that most medicinal plants in the region occur widely dispersed as weeds and are known primarily by the local common names preserved by the oral tradition. Confusion can arise in attempting to identify a particularly plant, particularly when the same name is given to two or more different plants. The authors discuss food consumption in the Caribbean, the traditional herbal remedies, and suggested future directions. One chart summarizes the antidiabetes plants in the Caribbean, including the plant’s Latin name, common name, and part used. 1 table. 48 references.
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Unproven Therapies. Diabetes Care. 25(Supplement 1): S133. January 2002.
The use of alternative therapies, some of which may have an impact on blood glucose levels, is widespread and growing in the United States. This brief article presents the American Diabetes Association position statement on unproven therapies. The article outlines the characteristics that unproven therapies tend to share, the categories assigned to treatment modalities, and the standards for established safety and efficacy. The article cautions that most patients do not openly share use of alternative therapies with their health care providers, so providers are encouraged to ask patients specifically about their alternative therapy practices. New and innovative, but unproven, diagnostic and therapeutic measures may be provided for patients in two circumstances: as part of an investigational trial that conforms to the U.S. Department of Health and Human Services regulations; or when a duly constituted review board or clinical investigations committee of an institution approves such use under provisions of compassionate use. 2 references.
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Biological Complementary Therapies: A Focus on Botanical Products in Diabetes. Diabetes Spectrum. 14(4): 199-208. October, 2001.
Several botanical (plant-based) and biological (animal based) products claim to lower blood glucose or decrease complications of diabetes, and some of these are being used by people with diabetes. This author focuses on the use of botanical products in managing diabetes. Products thought to lower blood glucose include gymnema, fenugreek, bitter melon, ginseng, and nopal. Claims have also been made for aloe, bilberry, and milk thistle, but there is less evidence in support of these. Botanical products thought to decrease diabetes complications include y-linolenic acid, ginkgo biloba, and garlic. A vitamin-like substance, alpha-lipoic acid, had been used to treat neuropathic complications. The author concludes that although these biological complementary therapies have been studied in human clinical trials, there are many problems with study design, study endpoints, numbers of patients, and study duration. There is insufficient evidence to recommend generalized use for patients with diabetes. Furthermore, these produces have many side effects and may potentially interact with traditional diabetes medications. 78 references.
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Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. 314 p.
This textbook on antidiabetic plants is from a series called Traditional Herbal Medicines for Modern Times. The series is designed to provide academia, health sciences, and the herbal medicines industry with in-depth coverage of the herbal remedies for infectious diseases and certain medical conditions, and the plant medicines of a particular country. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. The book offers 16 chapters that cover an introduction to diabetes mellitus; plants used in the treatment of diabetes; preclinical and clinical methods for evaluating the antidiabetic activity of plants; in vitro models for assessing antidiabetic activity; Ayurvedic, Siddha, and tribal medicine; traditional Chinese and Kampo medicines; treating non-insulin-dependent diabetes mellitus from a Western herbalist’s perspective; Native American medicine; antidiabetic plants in Mexico and Central America; antidiabetic plants in the Caribbean; management of diabetes in African traditional medicine; antidiabetic plants of North Africa and the Middle East; Australian and New Zealand plants with antidiabetic properties; plant polysaccharides in the prevention and treatment of diabetes; saponins; and flavinoids, xanthones, and other antioxidant polyphenols. Each chapter concludes with a lengthy list of references, and a detailed subject index concludes the volume.
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Association Between Complementary and Alternative Medicine Use, Preventive Care Practices, and Use of Conventional Medical Services Among Adults with Diabetes. Diabetes Care. 29(1): 15-19. January 2006.
There is an idea among practitioners of conventional medicine that patients who use complementary and alternative medicine (CAM) are less likely to use conventional medical services. This article reports on a study undertaken to asses the association between CAM use, preventive care practices, and use of conventional medical services among adults with diabetes. The authors report on data from 2,474 adults with diabetes, using an overall CAM-use category based on use of any of the following: diets, herbs, chiropractic care, yoga, relaxation, acupuncture, ayuverda, biofeedback, chelation, energy healing, Reiki therapy, hypnosis, massage, naturopathy, and homeopathy. Results showed that a total of 48 percent of adults with diabetes used some form of CAM. CAM use was independently associated with receipt of pneumonia vaccination but not significantly associated with receipt of influenza vaccination. CAM use was independently associated with visiting the emergency room, having six or more primary care visits, and having eight or more primary care visits. The authors conclude that CAM use may not be a barrier to use of conventional medical services in adults with diabetes. 3 tables. 23 references.
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Australian and New Zealand Plants with Antidiabetic Properties. IN: Soumyanath, A., ed. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 243-256.
This chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this chapter, the author describes Australian and New Zealand plants with antidiabetic properties. The author first reviews the geographic development of Australia and New Zealand, the indigenous people of these countries, and issues of Aboriginal health, including attitude to illness and epidemiology of diabetes. The chapter discusses two types of plants: plants included in traditional Aboriginal pharmacopoeias now known to exhibit hypoglycemic activity and Australian plant genera related to species with proven hypoglycemic activity but used in other parts of the world. The author concludes that remarkably little is known about Australian plants with antidiabetic properties and even less is known about the traditional use of these by the Aboriginal people. 1 figure. 1 table. 87 references.
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Complementary Medicine: Its Hidden Risks. Diabetes Care. 24(8): 1486-1488. August 2001.
This review article explores the hidden risks of complementary medicine (CM). CM options are being discussed as treatments for diabetes, but some forms of CM are clearly not totally devoid of risk. For example, acupuncture has caused deaths and other serious complications through infection and trauma, chiropractic treatment has done so through vertebral arterial dissection, and herbal medicines have caused serious complications through hepatotoxicity and nephrotoxicity. Although such events are rare, they represent an unknown that needs accounting for when addressing the issue of whether a given CM treatment does more good than harm. Some complementary therapies may be judged as entirely free of direct risks, but these treatments cause harm through indirect risks. The most obvious indirect risk is that complementary therapies may be used as true alternatives to conventional treatments for serious medical conditions. Other indirect risks of CM relate to the diagnostic methods used by some practitioners. Even less tangible risks associated with CM use include the lack of evidence supporting some CM techniques. Other intangible risks lie with the mindset of the typical CM user and the antiscience attitude that sometimes emerges from enthusiasts of CM. 1 figure. 24 references.
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Energy Therapies and Diabetes Mellitus. Diabetes Spectrum. 14(3): 149-153. August, 2001.
People with diabetes require multiple interventions to reach their glycemic goals. Energy therapies have been a useful aid improving health and well being. Clinical interventions involve energy exchange in some form. This article focuses on energy therapies that involve the presence of a therapist, whether local or long distance, to support and aid in the healing process. Energy or healing therapies include Therapeutic Touch (TT), Reiki, massage, Microwave Resonance Therapy (MRT), colored light therapy, and acupuncture. The literature on diabetes and healing therapies is sparse, but there is potential for energy therapy to assist individuals with diabetes in reaching goals for normoglycemia (normal levels of blood glucose) and high quality of life. The authors conclude that these therapies have few known side effects and many potential benefits. However, as with all unproved therapies, they should be approached with caution and careful monitoring. 1 table. 47 references.
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Ayurvedic, Siddha, and Tribal Medicine. IN: Menon, V.P.; Stanley Mainzen Prince, P. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 117-134.
This chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this chapter, the authors discuss Ayurvedic, Siddha, and tribal medicine of India. The authors describe the Indian medical tradition as having two levels: the classical system, which includes Ayurveda, Siddha, and Unani traditions and is characterized by institutionally trained doctors and well-developed theories to support its practices; and the folk system, called Lok Parampara, which is an oral tradition passed on from parent to child that includes knowledge and beliefs regarding foods, knowledge of diagnostic procedures and prevention measures, and the use of yoga and physical practices for disease prevention. The authors focus on six plants from these traditions: Syzigium cumini, Tinospora cordifolia, Trigonella foenum graecum, Momordica charantia, Gymnema sylvestre, and Pterocarpus marsupium. For each plant, they discuss the phytochemical factors, concluding that because diabetes is a multifunctional defect, care must be taken before administering any drugs, including plant-based agents. 142 references.
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Biological Complementary Therapies in Diabetes. IN: Mensing, C., ed. Art and Science of Diabetes Self-Management Education. Chicago, IL: American Association of Diabetes Educators. pp. 432-460.
Along with traditional medications, some people with diabetes have turned to use of nontraditional therapies, including complementary and alternative medicine (CAM). CAM therapies can include acupuncture, relaxation techniques, massage, chiropractic, and spiritual healing, as well as consumption of herbal medicine and megavitamins. This chapter on the use of biological complementary therapies in diabetes is from a comprehensive text that serves as a resource for all health professionals, community professionals, and individuals who provide education to individuals with diabetes. The authors note that many people with diabetes use dietary supplements to lower blood glucose or treat diabetes-related complications. However, there are concerns with the use of biological complementary therapies, including various, unregulated chemical ingredients and varying theorized mechanisms of action. As with other pharmacologically active agents, CAM therapies may produce side effects and drug interactions. Specific products discussed include: cinnamon, gymnema, fenugreek, bitter melon, ginseng, nopal, aloe vera, banaba, caiapo, bilberry, milk thistle, chromium, vanadium, garlic, St. John’s wort, and nicotinamide. Those involved in diabetes care and education should develop a clear understanding of biological complementary therapies to be able to provide unbiased, nonjudgemental information to patients about these therapies. The chapter includes a list of key points, a summary of teaching strategies, case studies, suggested Internet resources, a glossary of key terms, and a list of references. 3 tables. 157 references.
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Can Medication Help?. IN: Prediabetes Wake-Up Call: A Personal Road Map to Prevent Diabetes. Berkeley, CA: Ulysses Press. 2006. pp. 126-138.
This chapter on drug therapy is from a book about prediabetes, also called the metabolic syndrome. Written in non-technical language to help readers prevent or delay their progression to diabetes, the book uses a road map and automobile analogy to explain the strategies they can take to better health. In this chapter, the author describes the use of medications to help lower the risk of developing diabetes. There are glucose-lowering medications for people with diabetes which can work by helping the pancreas release more insulin, making the cells more sensitive to insulin, reducing the amount of glucose made by the liver, blocking digestion of carbohydrates or fat, or substituting for human insulin to help the cells use glucose. The author also outlines non-diabetes medications that may be useful, including anti-hypertensive agents or cholesterol-lowering drugs. Vitamin, mineral, and herbal supplements may also be used; the author outlines some of the studies on these alternative therapies, commenting on benefits, efficacy, and side effects reported. Readers are encouraged to work closely in tandem with their health care providers and to become an active, educated member of their own health care team. The author uses conversational language, with true stories and personal examples, and questions for consideration at the end of the chapter. 2 tables.
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Flavonoids, Xanthones, and Other Antioxidant Polyphenols. IN: Soumyanath, A., ed. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 293-304.
This chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this chapter, the authors describe flavinoids, xanthones, and other antioxidant polyphenols, naturally occurring compounds that can improve oxidative status, protect and enhance endogenous defenses, and directly mediate various mechanisms of pathology. After providing an overview of the role of oxidative stress in diabetes and its complications, the authors review current data linking antioxidant polyphenols and diabetes. The authors discuss the implications for understanding traditional uses of plants and their potential application in addressing contemporary diabetes problems. They conclude by calling for pharmacological screening that characterizes current research on plant antioxidants, which should be extended to a greater number of medicines and traditional foods. 6 figures. 92 references.
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In Vitro Models for Assessing Antidiabetic Activity. IN: Soumyanath, A., ed. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 99-116.
This chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this chapter, the authors review in vitro models for assessing antidiabetic activity. After a discussion of the rationale between the in vitro models used in diabetes research, they cover those models used to study inhibition of carbohydrate-digesting enzymes, to study inhibition of intestinal glucose uptake, to study insulin secretion from beta cells of the pancreas, those models based on the liver as an insulin target tissue, on adipocytes as an insulin target tissue, and on muscle as an insulin target tissue. Other sections cover interactions with the insulin receptor, glucagon receptor antagonists, potential interferents in plant extracts, solubilizing plant extracts for in vitro studies, and the use of an alternative glucose substrate for in vitro uptake studies. The authors conclude that in vitro tests offer a number of significant advantages for research on antidiabetic plants. A wide range of tests is available, based on various mechanisms that would alleviate hyperglycemia in diabetes. Multiple mechanisms and active components are possible in antidiabetic plants. 120 references.
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Introduction to Diabetes Mellitus. IN: Soumyanath, A., ed. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 1-18.
This introductory chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this introductory chapter, the author reviews the physiology and pathology of type 1 and type 2 diabetes. Topics include the physiological actions of insulin on glucose metabolism, on fat metabolism, and on protein metabolism; the physiological actions of glucagon; the molecular mechanisms of insulin action; classification of diabetes; clinical presentation and disease mechanisms in diabetes; the long-term complications of diabetes; the global burden of diabetes and ethnicity; diabetes treatment options that delay gastric emptying, reduce absorption of carbohydrate, increase pancreatic insulin secretion, reduce hepatic glucose output, increase insulin sensitivity, and alter renal glucose handling; weight loss and exercise; and challenges in patient care management. 5 figures. 3 tables. 85 references.
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Management of Diabetes in African Traditional Medicine. IN: Soumyanath, A., ed. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 203-120.
This chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this chapter, the authors describe the management of diabetes in African traditional medicine. The authors caution that phytochemical information is unavailable on the active constituents of many of the plants used in African traditional medicine. The authors discuss 19 families of plants, noting for each the Latin name, African name, description and distribution, and pharmacognosy. They note that, of the most popular plants growing in Asia and Africa, Gymnema sylvestre and Momordica species, have been found in various studies to be of benefit when used as adjunct therapy in type 2 diabetes. The authors conclude that, in most cases, these plants are cheap and easily accessible and should be promoted as part of the global strategy to combat diabetes once additional data supporting their use are available. 71 references.
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Native American Medicine. IN: Soumyanath, A., ed. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 169-178.
This chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this chapter, the authors present Native American medicine, focusing on the rise in prevalence of type 2 diabetes among Native Americans and the plants used to treat diabetes in North America. The bulk of the chapter consists of a chart of plants, including the plant’s Latin name, common name, part used, cultural affiliation, and reference that comments on the use of the plant. The authors conclude that new approaches are needed to slow the sharp rise in the incidence of diabetes among Native Americans. Several factors have been identified as playing contributing roles in the increase of diabetes, but dietary changes appear to be the most important influence. The reincorporation of traditional plant foods into the diet may help to reduce the incidence of diabetes because they may contain a number of beneficial phytochemicals. 3 tables. 54 references.
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Plant Polysaccharides in the Prevention and Treatment of Diabetes Mellitus. IN: Soumyanath, A., ed. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 257-272.
This chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this chapter, the authors describe the use of plant polysaccharides in the prevention and treatment of diabetes mellitus. Dietary polysaccharides are high molecular weight compounds with complex structures and properties. The author defines polysaccharides, examines the role of starch, and considers factors affecting the glycemic response to food, including the glycemic index and diabetes, the role of water-soluble nonstarch polysaccharides (NSP), and the mechanisms of action of viscous polysaccharides. As part of the intact plant cell wall, NSPs will affect the way in which the available carbohydrate is released from plant cells. Plant polysaccharide extracts that form viscous solutions in water have specific effects in reducing postprandial blood glucose. When added to foods, these soluble NSPs will reduce the glycemic index of carbohydrate-containing foods. A final section discusses new sources of plant polysaccharides. 3 figures. 1 table. 54 references.
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Rational Use of Dietary Supplements, Nutraceuticals, and Functional Foods for the Diabetic and Prediabetic Patient. IN: Brett, E.; Mechanick, J., eds. Nutritional Strategies for the Diabetic and Prediabetic Patient. . Boca Raton, FL: CRC Press. 2006. pp. 265-296.
This chapter on the use of dietary supplements, nutraceuticals, and functional foods is from a book written to advance physicians’ knowledge in nutrition as it relates to diabetes and to help them provide evidence-based recommendations to their patients with diabetes. The author notes that the use of dietary supplements, nutraceuticals, and functional foods (DS/N-FF) in clinical medicine has grown enormously, with many of these products targeted to diabetology. The author introduces the idea of complementary and alternative medicine (CAM) and discusses antidiabetic botanicals, including herbs, ayurveda, the traditional Chinese medical system, culinary botanicals, tea and coffee, wine, and other beverages. The next section discusses minerals, focusing on chromium, vanadium, magnesium, and zinc. This section is followed by a section on vitamin C, coenzyme Q10, glucosamine-chondroitin, and oral amino acids. A final section considers CAM treatments for diabetic peripheral neuropathy. For each treatment, the author assigns a letter grade, based on clinical evidence coupled with subjective assessments of risk and benefit; patients are advised to only use those products with a recommendation grade of A, B, or C. Physicians are encouraged to conduct focused discussions with their patients on the use of DS/N-FF. 11 tables. 296 references.
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Saponins. IN: Soumyanath, A., ed. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 273-292.
This chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this chapter, the authors review saponin research of the last decade, focusing on the hypoglycemic effects in experimentally diabetic animals and accelerating effects on glucose uptake in vitro. The authors also review recent studies of the antihyperglycemic effects of triterpene saponins. Most of the research studies reviewed are animal studies. 12 figures. 5 tables. 57 references.
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Traditional Chinese and Kampo Medicines. IN: Soumyanath, A., ed. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 135-150.
This chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this chapter, the authors discuss traditional Chinese and Kampo (Japanese) medicine. In traditional Chinese and Japanese medicines, except for urorrhagia and nephropathy, diseases that present with symptoms such as overintake of water due to polyuria and thirst are considered to be diabetes mellitus. The authors describe several representative formulations that have been applied for the treatment of diabetes mellitus. The chapter covers the hypoglycemic effect, inhibition of aldose reductase, and anti-Oketsu effect of the crude drugs used in the formulations as found in experimental models. Ten Kampo compounds are discussed, followed by a section on 13 herbs with hypoglycemic effects. Oketsu is blood stagnation or microcirculation difficulties. Kampo medicines are considered to be effective for the improvement of the symptoms associated with diabetes, including polydipsia, polyuria, and neuropathy. 1 table. 85 references.
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Herbal Remedies in Gastroenterology. Journal of Clinical Gastroenterology. 39(6): 457-468. July 2005.
Complementary and alternative medicine (CAM) is not considered part of conventional medicine. However, an estimated 51 percent of patients with gastrointestinal disorders have tried some form of CAM. Current prevalence rates show that 10 percent of patients with GI disorders are seeking alternative medicines remedies in place of conventional therapy. After prayer or spiritual healing, herbal medicine is the second most common CAM therapy. While herbal products make numerous health-related claims, those that have been systematically evaluated are unfortunately few. The modern gastroenterologist must be up to date with the regulations, side effects, and possible benefits of specific herbal products used in patients with gastrointestinal disorders.
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Herbs That Affect Blood Glucose Levels. Women's Health in Primary Care. 8(7): 325-330. August 2005.
Some herbs can have undesirable and possibly hazardous effects on blood glucose levels in women with diabetes, yet their use is quite common. This article explores adverse drug-herb interactions, focusing on herbs that affect blood glucose levels. The author notes that many herbal products are used at the same time with antidiabetes medications, with or without the knowledge of the patient’s clinicians. Herbs discussed include ginseng, fenugreek, bitter melon, garlic, onion, and plants containing catechin-related compounds (such as green tea). Catechins have an inhibitory activity against glucose transporters in the intestine, thus diminishing the amount of glucose absorbed. The polysaccharides in ginseng can lower blood glucose levels either by decreasing glucose production by the liver or by increasing glucose use by tissues. Components in garlic and onion have been shown to cause a glucose-lowering effect. Bitter melon enhances glucose use by the liver and reduces insulin resistance. The article includes a table of the major herbs that can influence blood glucose levels, along with their possible mechanisms of action; a second table lists the reasons for which women typically use these herbs. Women tend to use herbal products in a greater percentage than do men, so it is important for clinicians to routinely ask female patients with diabetes about the use of botanicals. 1 figure. 2 tables. 62 references.
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Treating Non-Insulin-Dependent Diabetes Mellitus from a Western Herbalist’s Perspective. IN: Soumyanath, A., ed. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 151-168.
This chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this chapter, the authors present a Western herbalist perspective on treating non-insulin-dependent diabetes, also called type 2 diabetes. The authors note that type 2 diabetes responds particularly well to botanical and nutritional therapies and some lifestyle changes, so full health and function may be restored. They discuss the use of traditional Western antidiabetic herbs, including bitters, barberry root bark, milk thistle, bilberry leaf and fruit, aloe vera, juniper, and goat’s rue. The authors consider the treatment of diabetes by modern Western herbs, including gymnema, fenugreek, suma, American ginseng, prickly pear, devil’s club, and queen’s crepe myrtle. Two final sections cover herbs for use in adjunctive therapies, including bilberry fruit, ginkgo biloba, and cayenne; and the roles of nutritional therapies and exercise. The authors conclude that, despite the fact that herbs used for diabetes are less likely to have the drawbacks of conventional drugs, potential adverse herb-drug interactions should be kept in mind for patients also taking conventional medications. 2 tables. 123 references.
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Biological Complementary Therapies in Diabetes. In: Franz, M.J., et al., eds. Core Curriculum for Diabetes Education. 5th ed. (Volume 4) Diabetes in the Life Cycle and Program Management. Chicago, IL: American Association of Diabetes Educator (AADE). 2003. p. 205-242.
Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Some of these therapies are used alone and referred to as alternative, while some are used in combination with other alternative or conventional therapies and are referred to as complementary. This chapter on biological complementary therapies in diabetes is from a handbook of the CORE Curriculum, a publication that helps educators prepare for the Certified Diabetes Educators (CDE) exam, serves as a key reference for the Advanced Diabetes Management credential exam, and provides an authoritative source of information for diabetes education, training, and management. This chapter focuses on biological complementary therapies, which include botanical, vitamin, and mineral products. Topics include the epidemiology of CAM use; why people with diabetes use CAM; reasons for concern with CAM use; the main components of the Dietary Supplement Health and Education Act (DSHEA) of 1994; how to evaluate claims from manufacturers of dietary supplements; biological complementary therapies commonly used in diabetes; the proposed mechanism of action of biological complementary therapies in diabetes; and side effects and drug interactions that may occur with use of biological complementary therapies. The chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). 155 references.
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Biological Complementary Therapies in Diabetes. In: Franz, M.J., et al, eds. Core Curriculum for Diabetes Education. 4th ed.: (Volume 4) Diabetes in the Life Cycle and Research. Chicago, IL: American Association of Diabetes Educators (AADE). 2001. p. 151-184.
In the United States and worldwide, the use of complementary and alternative medicines (CAM) is increasing. Some of these therapies are used alone and thus referred to as alternative; some are used in combination with other therapies and referred to as complementary. This chapter on biological complementary therapies in diabetes is from a book that is the fourth in a series of four texts that make up a Core Curriculum, designed primarily to help educators prepare for the Certified Diabetes Educator (CDE) exam. Topics include the epidemiology of use of CAM; reasons why patients use CAM; concerns regarding the use of CAM; the main components of the Dietary Supplement Health and Education Act (DSHEA) of 1994; how to evaluate claims from manufacturers of dietary supplements; biological complementary therapies commonly used in diabetes; the proposed mechanism of action of biological complementary therapies in diabetes; side effects and drug interactions that may occur with use of biological complementary therapies; information and recommendations to provide to patients with diabetes regarding these therapies; and how to talk with patients in a nonjudgmental manner about the use of biological complementary therapies. The chapter lists the learning objectives for that chapter, presents information in outline and bulleted format, summarizes the key educational considerations, offers self review questions and questions for discussion, presents illustrative case reports, and concludes with a list of references. A post-test and the answers to the post-test questions are appended to the chapter. 122 references.
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Guidelines for Using Vitamin, Mineral, and Herbal Supplements. Diabetes Spectrum. 14(3): 160. August, 2001.
The use of vitamin, mineral, and other complementary nutrition-based therapies has increased dramatically in the United States. Many health care providers are also beginning to explore the use of these therapies in their practices. This patient education handout offers guidelines for using vitamin, mineral, and herbal supplements. These suggestions include learn about the supplements, discuss supplements with the health care provider, keep records, know what benefits to expect, add only one new product at a time, carefully follow dosage guidelines on labels, do not combine supplements and prescription drugs without the physician's knowledge, never stop taking a prescribed drug without the physician's knowledge, stop using supplements at the signs of any bad side effects, do not use supplements during pregnancy or nursing, do not give supplements to young children, stop using all supplements before surgery, anesthesia, and other medical procedures, and store capsules and tablets in a cool dark place. One sidebar summarizes recommendations for choosing a supplement.
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Harrison's Principles of Internal Medicine. 15th ed. Columbus, OH: McGraw-Hill Companies. 2001. 2629 p.
This comprehensive textbook covers all aspects of internal medicine. The first five sections serve as an introduction and cover decision making, cost considerations, alternative medicine, special populations, medical ethics, cardinal manifestations and presentations of disease, genetics and disease, clinical pharmacology, and nutrition. The core of the book encompasses the disorders of the organ systems and is contained in parts Six through Fifteen: oncology and hematology, infectious diseases, disorders of the cardiovascular system, disorders of the kidney and urinary tract, disorders of the gastrointestinal system, disorders of the immune system, connective tissue, and joints, endocrinology and metabolism, neurologic disorders, and environmental and occupational hazards. Each section includes 5 to 12 chapters, written by specialists in each field. Numerous tables and figures illustrate each chapter and references are listed at the end of each chapter. An extensive subject index concludes the volume.
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Herbal Therapies and Diabetes Complications. Diabetes Self-Management. 18(1): 87-88, 91-92, 95-96, 98. January-February 2001.
This article, the third of a series of articles on herbal therapies, reviews herbal and alternative therapy supplements for the treatment of diabetic complications. Both the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Trial (UKPDS) demonstrated that keeping blood glucose levels as close to normal as possible can delay or prevent the development of complications in people with either type 1 or type 2 diabetes. Some of the new, experimental treatments for complications of diabetes include nutritional and herbal supplements. Many supplements may be of potential benefit in the treatment or prevention of heart disease, including fish oil, fenugreek, garlic, red yeast, antioxidants, and several herbs that inhibit blood clotting such as ginger, garlic, gingko biloba, and ginseng. The symptoms of peripheral neuropathy may be eased with alpha lipoic acid, capsaicin, and evening primrose oil. Although bilberry and gingko biloba have both been proposed as potential treatments for diabetic retinopathy, neither is currently recommended for this use. The herb yohimbe has a reputation as a aphrodisiac and a treatment for impotence, but clinical trials do not support its use. There are several experimental drugs and some herbal supplements that may prevent damage caused by the conversion of extra glucose in the cells into sorbitol, including flavonoids, quercetin, and extracts from licorice root. Although being overweight is not considered a complication of diabetes, it can make controlling blood glucose levels more difficult. Losing a small amount of weight can lower both blood glucose and blood cholesterol levels. Numerous herbal and nutritional supplements exist for people who are trying to lose weight. Common ingredients found in herbal weight loss preparations include various diuretics and laxatives, guarana, ephedra, and garcinia. The article reviews studies on these products, identifies their adverse effects, and presents typical dosing regimens. In addition, the article provides guidelines for safe supplement use and lists suggestions for further reading. 1 table.
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Is Massage Useful in the Management of Diabetes?: A Systematic Review. Diabetes Spectrum. 14(4): 218-224. October, 2001.
Massage is among the fastest growing complementary therapies used in the United States. This article systematically reviews the available evidence on potential benefits and adverse effects of massage for people with diabetes. Massage at injection sites may increase insulin absorption, thereby decreasing blood glucose levels in people with type 1 diabetes. It is unclear whether massage can improve insulin sensitivity and therefore be a useful adjunct to the management of diabetes for those with type 2 diabetes. In addition, uncontrolled studies suggest that massage may have a positive effect on blood glucose (sugar) levels and symptoms of diabetic neuropathy (nerve disease associated with diabetes). However, randomized, placebo controlled studies are needed to confirm any short and long term benefits of massage as a complementary treatment for diabetes and to further define an optimal massage treatment. 38 references.
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Step-by-Step Approach to Complementary Therapies. Diabetes Spectrum. 14(4): 225. October, 2001.
This patient education handout helps people with diabetes incorporate complementary therapies into their diabetes management programs. The fact sheet notes that often the greatest levels of health and well-being can be reached when people have an integrative medical care team that is trained not only in the latest treatments and technologies, but also in how to create a healing environment for the mind, body, and spirit. Integrative care includes the best of standard medical care and complementary therapies as well as patients' full involvement in mind, body, and spirit. The fact sheet outlines five steps: identify the symptom that the patient hopes to improve, identify possible complementary therapies, interview potential complementary therapy providers, choose a complementary therapy provider and being treatment, and follow up regularly with both complementary and standard care providers. The fact sheet concludes with the contact information for the National Center for Complementary and Alternative Medicine (NCCAM, formerly the National Institutes of Health Office of Alternative Medicine) at 800-531-1794 or http://altmed.od.nih.gov.
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Therapeutic Massage: Complementary Health Care for Diabetes. Diabetes Self-Management. 17(6): 111-112, 114. November-December 2000.
This article discusses the use of therapeutic massage in the treatment of diabetes. There are many benefits of massage therapy for people who have diabetes, including inducing relaxation, increasing circulation, and facilitating greater mobility in the body. Personnel at a clinic providing massage to people with diabetes have observed the benefits of therapeutic massage and obtained data on the changes that occur in blood glucose levels during massage. People receiving massage have reported greater levels of physical and emotional comfort after the session than before. In addition, data on blood glucose changes reveal that massage therapy tended to lower blood glucose levels by approximately 20 to 40 milligrams per deciliter. Although the massage clinic is not a scientifically controlled study, it raises an important safety issue about awareness and treatment of hypoglycemia. People who have diabetes need to inform their massage therapist about their diabetes, describe the signs and symptoms they experience when their blood glucose is low, explain how to treat hypoglycemia, and make their needs known to their therapist. The article includes a list of resources concerning massage therapy.
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Mind-Body Interventions. Diabetes Spectrum. 14(4): 213-217. October, 2001.
Mind-body interventions utilize the mind's capacity to affect the body and its physiological responses; they thus influence health. The response to stress (the 'fight or flight' reaction) may be automatic, but recovery toward relaxed parameters can be learned through self-regulation and the regular use of mind-body interventions. This article reviews mind-body interventions and their application for people with diabetes. The author notes that many of these interventions originate from Eastern healing practices. Western science has found some of them to be helpful as adjunct modalities in the treatment of disease, and their use is increasing. Mind-body therapies regard as essential an approach that acknowledges each person's capacity for self-knowledge and self-care. Illness is viewed not as an obstacle but as an opportunity for personal growth and transformation. Mind-body interventions can include relaxation, meditation, hypnosis, imagery, visualization, autogenic training, aromatherapy, biofeedback, psychotherapy, support groups, dance and exercise, yoga, and music and art. Most of these therapies involve patient education, supervised practice, and regular practice at home. Practitioners and providers who want to incorporate mind-body interventions may need to educate their hospital and clinic administrators about these therapies. On the other hand, the author notes that practitioners of spirituality and mind-body interventions need to be more appreciative of the successes that the scientific practice of medicine has made available. Together, they can help achieve the most beneficial results possible. One table offers a list of resources for reference and training in mind-body interventions. 2 tables. 37 references.
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Select Vitamins and Minerals in the Management of Diabetes. Diabetes Spectrum. 14(3): 133-148. August, 2001.
The use of vitamin, mineral, and other complementary nutrition-based therapies has increased dramatically in the United States. Many health care providers are also beginning to explore the use of these therapies in their practices. For those providers who work in conventional health care settings, this is a new venture. But for many patients who have been self-medicating with supplements, it is nothing new. This article reviews how micronutrient requirements are determined and summarizes current recommendations for supplementation and the most pertinent research on the use of key vitamins and minerals in diabetes management. Micronutrients are vitamins and minerals that the body requires in small quantities for specific functions. The American Diabetes Association (ADA) and the American Dietetic Association recommend that healthy people at low risk for nutritional deficiencies meet their nutritional requirements with natural food sources. The ADA does note that people who are at increased risk for micronutrient deficiencies, such as those following very low calorie (VLC) diets, the elderly, strict vegetarians, and other special populations, may benefit from multivitamin supplements. The author reviews selected micronutrients, including chromium, vanadium, nicotinamide (a form of vitamin B3), magnesium, vitamin E, and B vitamins involved in homocysteine metabolism. Readers are encouraged to be open to new treatment regimens while also serving as careful watchdogs for ineffective or dangerous therapies. Health care providers should encourage their patients' involvement in and ownership of their diabetes, and help them to focus their efforts where they are likely to receive the greatest benefits. A patient education handout on this topic is also available in this issue. 5 tables. 95 references.
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Traditional Chinese Medicine in the Treatment of Diabetes. Diabetes Spectrum. 14(3): 154-159. August, 2001.
Traditional Chinese medicine (TCM) is a system of healing that is thousands of years old. TCM has long been utilized in the Chinese culture to treat the complex of symptoms that Western medicine terms diabetes mellitus. This article outlines the key concepts and therapies of TCM that play a role in the evaluation and treatment of patients with diabetes. The most commonly employed therapeutic methods in TCM include acupuncture (moxibustion), Chinese herbal medicine, diet therapy, mind and body exercises (Qidong and Tai Chi), and Tui Na (Chinese massage). TCM does not offer a cure for diabetes, but instead aims to optimize the body's ability to function normally. The author stresses that there is still a great need for more and better research on the efficacy and safety of both Chinese herbals, which are being used along with or in lieu of Western pharmaceuticals, and acupuncture in the care of patients with diabetes. Patients, TCM practitioners, and physicians who choose to integrate the two forms of care must all recognize the importance of careful monitoring of blood glucose levels, as well as monitoring for potential side effects such as drug-herb interactions. The author concludes that by remaining open to alternative forms of care and educating themselves about the safety and efficacy of these modalities, health care providers can offer maximum benefits for their patients. 2 figures. 2 tables. 16 references.
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Unproven Therapies. Diabetes Care. 23(Supplement 1): S110. January 2000.
This position statement focuses on unproven therapies for diabetes. The statement outlines the characteristics shared by proven and unproven therapies, explains how the American Diabetes Association evaluates questionable diagnostic and therapeutic modalities and characterizes therapeutic modalities, and identifies the features that qualify a diagnostic or therapeutic modality as safe and effective. In addition, the position statement presents the circumstances when new and innovative, but unproven, diagnostic and therapeutic measures may be used for patients who have diabetes.
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Alternative and Complementary Diabetes Care: How to Combine Natural and Traditional Therapies. New York, NY: John Wiley and Sons, Inc. 2000. 244 p.
This book provides people who have diabetes with information on alternative and complementary healing regimens for diabetes. The book is organized in a way to help readers remember what a full, balanced health program should include. This is done by using the acronym PARENT, which stands for positive thinking, assertiveness, relaxation, exercise, nutrition, and touch. Chapter one provides an overview of the field of alternative and complimentary care. Topics include the activities of the Office of Alternative Medicine to assist professionals and lay people in recognizing the most helpful treatments, the steps some medical schools are taking to teach future physicians about alternative treatment approaches, and models of practice. Chapter two focuses on positive thinking. Readers learn how positive thinking affects the body from the standpoint of laughter, prayer, reframing, meditation, thought stopping, problem solving, and other choices. Considerations related to blood sugar control address logical thinking versus various other approaches to management. Chapter three deals with assertiveness, focusing on how to use assertiveness in daily life, how to handle conflict, how to develop a win-win approach, how to handle anger, and how using assertiveness relates to blood glucose control. Chapter four explains the physiology of stress and examines the effect of relaxation on blood glucose levels. Relaxation methods include biofeedback, progressive relaxation, autogenic therapy, deep breathing, imagery, visualization, aroma therapy, and meditation. Chapter five provides guidelines for evaluating one's present physical condition in relation to safe exercise choices. Types of exercise include aerobics, muscle strengthening, tension relievers, tai chi, qigong, other martial arts, and hatha yoga. Chapter six focuses on nutrition and diets. Topics include diet programs, obesity, weight loss, and types of foods. Chapter seven discusses the use of herbs in terms of general considerations, the availability and safety of herbs, regulation problems, and the usefulness of herbs. In addition, the chapter reviews products that people with diabetes might read or hear about and identifies specialty practices that use herbs. Chapter eight provides information on therapies that have something to do, directly or indirectly, with various energy responses of the mind or body, including art therapy, aroma therapy, colon therapy, chiropractic therapy, osteopathic therapy, homeopathic therapy, hypnotherapy, imagery therapy, journaling therapy, music therapy, magnet therapy, thought field therapy, and pain management therapy. Chapter nine introduces touch and nontouch remedies and various therapies that have the potential to lead to improved circulation, improved balance, and an improved sense of well being. Chapter 10 offers general reminders about the use of alternative remedies and provides some suggestions to improve quality of life. 7 appendices. 1 figure. 45 references.
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Consumer Health Information Source Book. 6th ed. Phoenix, AZ: Oryx Press. 2000. 323 p.
This source book serves as a comprehensive guide to popular health information resources of value to the general public. This edition of the source book brings together more than 3,000 descriptive evaluations of health information resources. Chapter one discusses trends in medical consumerism. These trends relate to the impact of the Internet, the Patients' Bill of Rights, federal information initiatives, the rise of alternative medicine, direct to the consumer advertising by drug manufacturers, and increased use of e-mail. Other topics include trends in print and electronic publishing and present and emerging library roles within the context of the new information technology. Chapter two lists 142 outstanding consumer health information resources, including books, magazines, newsletters, pamphlet series, clearinghouses, fax based services, electronic products and services, Web sites and gateways, television coverage, and supportive professional books and journals. Chapter three identifies health information clearinghouses, information centers, toll free hotlines, health-related organizations, and search services. Chapter four describes trends in the publication of popular medical magazines and newsletters and describes more than 170 publications. The chapter also covers newsletters of voluntary health associations and periodic overview reports. Chapter five focuses on dial-up fax consumer health information services, CD-ROM and diskette products, online services, and personal health software for institutional and personal use. Chapter six reviews current developments on the Internet and discusses the significance and usefulness of the Internet to medical consumers. Chapter seven reviews 70 selected Internet sites and the most useful search engines, directories, and gateways. Chapter eight discusses supportive professional literature. Chapter nine consists of 491 reviews of consumer health books written from the mainstream medical approach. Chapter 10 provides reviews of 144 books on complementary and alternative medicine. Chapter 11 lists some 1,500 English language pamphlet titles produced by various organizations. The pamphlets cover a wide range of topics and are arranged in 57 topical areas. The final chapter lists more than 600 Spanish language pamphlet titles listed under 40 Spanish language topics arranged alphabetically by Spanish name. References to diabetes are included in many chapters. The source book includes author, title, and subject indexes. 18 figures. Numerous references.
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Herbal Supplements in Diabetes Management. Diabetes Self-Management. 17(6): 28, 30-31, 35-37. November-December 2000.
This article, the second of a series of articles on herbal therapies, reviews some of the most promising blood sugar lowering herbals, including bitter melon, fenugreek, gurmar, goat's rue, bilberry, ginseng, nopal cactus, and garlic and onions. Bitter melon is the most widely used traditional remedy for diabetes in Asia and Africa. As a treatment for diabetes, the juice or an extract of the unripe fruit is used. Compounds isolated from bitter melon believed to be responsible for its blood sugar lowering properties include charantin and plant insulin. No well designed studies using bitter melon in humans have been conducted. Fenugreek is a common spice. Its seeds or a defatted powder made from the seed have been used as a diabetes treatment. Studies of fenugreek suggest that it has hypoglycemic activity and that it may improve blood cholesterol and triglyceride levels. Gurmar, or gymnema sylvestre leaf, has been used as a traditional treatment for diabetes in India. Gymnema is believed to act by improving the function of the pancreatic beta cells. There is minimal research on gymnema, and the studies conducted in humans have not been well designed. Goat's rue is another traditional remedy for diabetes that has been shown to have hypoglycemic activity in humans. The leaves of bilberry have been used as an antidiabetic tea. However, chronic consumption of bilberry leaf or capsules is not recommended because they can be toxic. Ginseng, which is sold chiefly as an energy booster in the United States, has been investigated as a diabetes remedy in only a few small studies. The stem or leaf of nopal cactus has been used in traditional Mexican medicine to treat type 2 diabetes. Garlic and onions have been used as folk medicines to treat diabetes, and a few studies suggest that they may have some mild blood sugar lowering properties. The article reviews studies on these products, identifies their adverse effects, and presents typical dosing regimens. In addition, the article lists potentially dangerous plant products and provides guidelines for safe supplement use. 1 figure.
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