Complementary and Alternative Treatments for Diabetes
An increasing number of people in the US and elsewhere who have chronic diseases like diabetes are using treatments outside of mainstream medicine to help them manage diabetes, its complications and to improve their quality of life. Alternative treatments encompass a wide range of therapies sometimes referred to as complementary and alternative medicine (CAM).1
Alternative medicine is a term that means any medicinal products or practices that are not part of mainstream medicine given by medical doctors or allied health professionals, such as nurses or physical therapists. Alternative medicine is also defined by its use as an alternative to traditional medical care. Complementary medicine is used in combination with traditional medicine. Alternative and complementary medicine are not reviewed by the FDA and patients are encouraged to talk to their doctor before starting any therapies they are using to manage their condition.2
Complementary and alternative approaches used for diabetes include: 1
- Massage Therapy
- Chiropractic Care
- Qi gong and Tai chi
Yoga is a spiritual, physical, and mental discipline developed in India thousands of years ago. It involves exercise, relaxation, breath control, and healing, with origins in Indian philosophy. Yoga may have been practiced as long ago as 5,000 years, but the first known work describing the practice was the Yoga Sutras, written over 2,000 years ago.3
Several studies have been conducted to evaluate the effects of the regular practice of yoga on diabetes control. In one randomized controlled study conducted in 123 adults with type 2 diabetes, yoga plus standard care was compared to standard care alone. The group of patients who took part in yoga in addition to standard treatments had significantly greater improvements in glycemic control (non-fasting blood glucose, hemoglobin A1C levels) and body weight compared with patients who received only standard treatments. Another randomized controlled study comparing a yogic breathing practice plus standard treatment with standard treatment alone in a group of 49 patients with type 2 diabetes found that the combination resulted in an insignificant trend towards greater improvement in glycemic control, however, significant improvements in quality of life measurements, including physical, psychological and social functioning. Further research is needed to confirm these potential benefits of yoga in patients with type 2 diabetes.1
Meditation has been practiced in various forms for thousands of years, with many techniques developed within the world’s religions, including Hindu, Buddhist, and Judeo-Christian traditions. Meditation has become very popular and is often practiced apart from any religious tradition and is used widely in healthcare settings. Meditation is also an integral part of other alternative medicine systems, including yoga and traditional Chinese medicine. Such practices have the goal of achieving a balance in state of awareness, that over time may develop into permanent habits of thinking and behavior with value in counteracting stress and improving mood.1
Meditation and mindfulness practices have been evaluated for management of chronic diseases including diabetes in several studies. Results from a 1-year analysis of the Heidelberger Diabetes and Stress Study, a long-term (5-year) randomized, controlled trial of a system of mindfulness training (Mindfulness Based Stress Reduction [MBSR]) in patients with type 2 diabetes, found that the practice resulted in significant improvements in mood (levels of depression), mental health status and blood pressure. Other studies assessing different approaches to mindfulness/meditation training have failed to find similar quality of life and functional improvements, perhaps due to the small number of patients involved or the intervention used.1
Acupuncture is part of the larger system of traditional Chinese medicine, which combines a variety of nutritional, herbal, and mind-body approaches. Acupuncture is an ancient treatment approach developed in China 5,000 years ago based on the theory that the body contains a network of energy (chi is the term for this energy) pathways and that points (acupuncture points) throughout this network function as gates that allow the energy to flow through the body. Acupuncture involves the placement of needles (as well as the use of heat from burning herbs) at acupuncture points on the body to facilitate the flow of energy.4
Research in the use of acupuncture in management of diabetes and related complications is limited methodologically by the difficulty of establishing an adequate control (such as insertion of needles in body locations other than acupuncture points). Recent reviews of existing studies of acupuncture in patients with type 2 diabetes and insulin resistance have acknowledged this limitation and others have concluded that there is currently insufficient evidence to recommend acupuncture as an effective treatment tool in diabetes management. However, promising results from selected studies showing some possible effect on blood glucose and other markers of glycemic control suggest that further study of acupuncture in diabetes care is warranted.1
Even if serious questions remain concerning the usefulness of acupuncture and similar interventions in glycemic control, some research has shown that acupuncture may be useful in managing diabetes complications affecting peripheral nerves. One small randomized, placebo-controlled trial of acupuncture in 42 patients with diabetic neuropathy found that patients who received 15 days of acupuncture treatments had significant improvements in motor and sensory function compared with the patient group that received sham treatments.1
Massage therapy is among the fastest growing complementary therapies used in the US. It is often recommended for diabetes management, but the usefulness of massage therapy for people living with diabetes remains unclear.
A few uncontrolled studies have concluded that massages may have a positive impact on blood glucose levels and diabetic neuropathy. However, more randomized controlled studies are required to confirm any short or long term benefits of massage as a complementary therapy for diabetes and to define a concrete massage treatment regimen.5
Chiropractic is a natural form of healthcare that uses spinal adjustments to correct misalignments and restore proper function to the nervous system, helping the body to heal naturally. There isn’t any evidence that chiropractic care helps with blood glucose control or diabetes management.
However, chiropractic can be beneficial for helping with the musculoskeletal manifestations of diabetes that some people experience, such as muscle cramps, carpal tunnel syndrome, frozen shoulder and peripheral neuropathy.6
Qi gong and Tai chi
Qi gong (which means breath work/technique in Mandarin Chinese: qi [or chi] translates as vital energy) is another modality that is part of traditional Chinese medicine. It involves energy-based healing practices that derive from Taoism (a school of Chinese philosophy) and Chinese medical theories. The approach is based on the idea that vital energy moves through a network of energy pathways in the body, and that breath or breathing can be managed to optimize this vital energy and maintain good health and stamina.7
Tai Chi is a Chinese martial art that has been practiced for centuries for both self-defense and health benefits. It involves a system of movements and postures designed to approach the mind and body in a holistic manner as an interconnected system. Tai Chi is believed to provide health benefits for the body, including increased strength, flexibility, coordination, and improved posture, and the mind, including reduction in stress, improvement in memory and concentration, and decrease in anxiety.8
Systematic reviews of studies evaluating Qi gong and Tai chi have failed to find sufficient evidence of their benefit to be recommended as an effective treatment for diabetes control. However, studies have reported other important benefits that can impact glycemic control, including improved fitness and weight loss. One recent randomized, controlled trial of 12-week Qi gong intervention in 41 individuals with untreated hyperglycemia reported several significant improvements versus controls, including weight loss, decreased waist circumference, improved strength, improved glycemic control (decreased A1C), and decreased insulin resistance. A recent randomized, controlled trial compared a 12-week program of gentle Tai chi in obese patients with type 2 diabetes to a standard exercise program. Tai chi resulted in significant improvements in body weight, triglycerides, and high-density lipoprotein (HDL) cholesterol, without any change in A1C levels.1
Apart from the lack of strong evidence for the benefit of Qi gong and Tai chi in glycemic control, the strength of these practices is that they are suitable for most patients with diabetes, regardless of fitness level, age, or weight status. Under adequate supervision, they are effective exercise options for most patients and can provide important benefits in fitness and weight loss with the potential to impact glycemic control.1 Always check with your physician before beginning any new exercise regimen.