Alternative Therapies for Type 2 Diabetes

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org

Alternative Medicine Review 2002 (Feb);   7 (1):   45–58 ~ FULL TEXT

Lucy Dey, MD, Anoja S. Attele, DDS, Chun-Su Yuan, MD, PhD


Introduction

Diabetes mellitus is a serious chronic metabolic disorder that has a significant impact on the health, quality of life, and life expectancy of patients, as well as on the health care system. In the United States, diabetes is the sixth leading cause of death. [ 1 ] Diabetes is divided into two major categories: type 1 diabetes (formerly known as insulin-dependent diabetes mellitus or IDDM) and type 2 diabetes (formerly known as non-insulin dependent diabetes mellitus or NIDDM). The overall prevalence of diabetes is approximately six percent of the population, of which 90 percent is type 2. [ 2 ] Treatment and care of diabetes represents a substantial portion of the national health care expenditure, over $105 billion annually. This represents a substantial portion of the health care expenditure ­ more than one of every 10 U. S. health care dollars and one of four Medicare dollars. [ 3 ]

Type 2 diabetes represents a syndrome with disordered metabolism of carbohydrate and fat. The most prominent clinical feature is hyperglycemia (fasting plasma glucose level > 126 mg/dL, or glycosylated hemoglobin A1c (HbA1c) > 6.9%). [ 4 ] In most patients with type 2 diabetes, the onset is in adulthood, most commonly in obese people over 40 years of age. Hypertension, hyperlipidemia, hyperinsulinemia, and atherosclerosis are often associated with diabetes.


Pathophysiology and Complications

Type 2 diabetes is known to have a strong genetic component with contributing environmental determinants. Although the disease is genetically heterogeneous, there appears to be a fairly consistent phenotype once the disease is fully manifested. Whatever the pathogenic causes, the early stage of type 2 diabetes is characterized by insulin resistance in insulin-targeting tissues, mainly the liver, skeletal muscle, and adipocytes. Insulin resistance in these tissues is associated with excessive glucose production by the liver and impaired glucose utilization by peripheral tissues, especially muscle. These events undermine metabolic homeostasis, but may not directly lead to overt diabetes in the early stage. With increased insulin secretion to compensate for insulin resistance, baseline blood glucose levels can be maintained within normal ranges, but the patients may demonstrate impaired responses to prandial carbohydrate loading and to oral glucose tolerance tests. The chronic over-stimulation of insulin secretion gradually diminishes and eventually exhausts the islet beta-cell reserve. A state of absolute insulin deficiency ensues and overt clinical diabetes becomes fully blown. [ 5-7 ] The transition of impaired glucose tolerance to type 2 diabetes can also be influenced by ethnicity, degree of obesity, distribution of body fat, sedentary lifestyle, aging, and other concomitant medical conditions. [ 8 ]

The quality of life of type 2 diabetic patients with chronic and severe hypoglycemia is adversely affected. Characteristic symptoms of tiredness and lethargy can become severe and lead to a decrease in work performance in adults and an increase of falls in the elderly. [ 9 ] The most common acute complications are metabolic problems (hyperosmolar hyperglycemic nonketotic syndrome or HHNS) and infection. The long-term complications are macrovascular complications (hypertension, dyslipidemia, myocardial infarction, stroke), microvascular complications (retinopathy, nephropathy, diabetic neuropathy, diarrhea, neurogenic bladder, impaired cardiovascular reflexes, sexual dysfunction), and diabetic foot disorders. [ 9 ]

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