LEVEL 4 AND 5 INTERVENTIONS IN TYPE 2 DIABETES:

Acupuncture as a Level 4 Intervention in the treatment of Type 2 Diabetes:

Type 2 diabetes (T2D) can be a difficult disease to deal with because of the many secondary health issues that may arise for those with the disease. Not only do diabetics need to monitor their blood glucose with many needing daily insulin injections, but often related issues like neuropathy, weight gain, depression, heart disease, kidney disease, vascular disease and chronic wounds can occur as a result of type 2 diabetes. (American Diabetes Association)

In applying the model of Consciousness Based Medicine (CBM) this paper will examine both a level 4 (touch) and level 5 (herbs/supplements) intervention in the treatment of type 2 diabetes.

Of the secondary health issues found in patients with T2D, peripheral neuropathy is one that causes significant pain and distress. Peripheral neuropathy (PN) results from damage to the peripheral nervous system caused by chronically high blood sugar and is characterized by symptoms such as numbness, burning, muscle weakness, and organ dysfunction. (American Heritage Medical Dictionary). Acupuncture in the use of pain management may be a viable treatment in PN as an alternative to pharmacology.

Acupuncture is one of the main forms of treatment in Traditional Chinese Medicine (TCM). It involves the use of fine needles that are inserted into the body at very specific points. This process is believed to adjust and alter the body's energy flow into healthier patterns and is used to treat a wide variety of illnesses and health conditions. (Gale Encyclopedia of Medicine) In TCM, it is believed that acupuncture helps balance the flow of energy, or qi within the body, which stimulates the body’s healing abilities. From the point of view of Western medicine, acupuncture stimulates the nerves and muscles which in turn can boost the body’s response to pain and improves blood circulation. The needles used in acupuncture are inserted into the body’s pressure points to stimulate the nervous system releasing endorphins which are your body’s natural painkillers and can change your body’s response to pain. (Wilson, 2017)

In a study conducted in 2010 by Zhang Cheng, Ma Yuan-Xu & Yan Ye, the clinical effects of acupuncture for the improvement of diabetic peripheral neuropathy was conducted with favorable results. In order to observe the clinical effects of acupuncture for PN, a study consisting of 65 patients who were randomly divided into a treatment group of 32 cases and a control group of 33 cases, acupuncture was used in the treatment group and inositol was orally administered in the control group. During a 3-month treatment period, changes in the symptoms were observed. (Zhang et al. 2010) All the patients were conventionally treated, with fasting blood glucose (FBG) below 7.0 mmol/L and 2 h BG below 11.1 mmol/L. For those diabetics complicated with hypertension and hyperlipemia, their blood pressure and blood lipid were controlled to the normal range and the diet was rationally controlled. (p. 14) For the treatment group, 25 acupuncture points related to blood stasis, phlegm and severe numbness of the hands and feet were treated. The needles were inserted in to each of the 25 points, with even lifting and twirling until the patients felt the needling sensation. Then, the needles were retained for 25 minutes, and manipulated twice. The treatment was given once a day, with 14 sessions as one course of treatment, for 5 consecutive courses with a 4-day interval between courses. (p. 14) For the control group, inositol was orally taken 2 g, 3 times daily. Three months later, the clinical effects were evaluated for both of the two groups. (p. 14)

It is important to note the criteria used to evaluate the results. The results were measured by three defining characteristics of improvement:

Markedly relieved: the subjective symptoms disappeared, with no abnormalities found in examination of the nervous system.
Improved: the subjective symptoms were alleviated or the affected area was reduced, with improvement shown by the nervous system examination.
Failed: the subjective symptoms were not improved or even aggravated.

The findings of this study showed in the treatment group of 32 cases, 16 cases were markedly relieved, 12 cases improved, and 4 cases failed, with a total effective rate of 87.5%. In the

control group of 33 cases, 7 cases were markedly relieved, 14 cases improved, and 12 cases failed, with a total effective rate of 63.6%. (Zhang et al. 2010)

Acupuncture, in this study showed excellent results in the treatment group with a 23.9% greater effective rate than the control group using only inositol supplements, making it a valid level 4 intervention in the relief of painful peripheral neuropathy experienced by those with type 2 diabetes. Furthermore, acupuncture as a mode of treatment for pain, may eliminate or at least reduce the need for harmful pain-killing drugs which are often accompanied by side effects. There is also the benefit of improved mood and overall well-being by reducing pain utilizing a method that does not produce unwanted side-effects.

Supplements as a Level 5 Intervention in the treatment of Type 2 Diabetes:

In reviewing level 5 interventions in the CBM model which utilizes supplementation, I found a study looking at the beneficial effects of inorganic chromium and brewer’s yeast supplementation on glucose tolerance, serum lipids and drug dosage in individuals with type 2 diabetes. In a double blind cross-over study consisting of four stages each lasting 8 weeks, 78 T2D patients were divided randomly into two groups and given Brewer’s yeast (23.3ug Cr/day), and chromium CrCl3 (200ug Cr/day) sequentially with a placebo in between. At the beginning and end of each stage, subjects were weighed, their dietary data and drug dosage recorded, and blood and urine samples were collected for analysis of glucose (fasting and 2 hour post 75g glucose load) fructosamine, triglycerides, total and HDL-cholesterol, and serum and urinary chromium. (Bahijiri et al. 2000)

The findings showed that both supplements caused a significant decrease in the means of glucose. The means of HDL cholesterol, serum cholesterol and urinary chromium were all increased. The mean drug dosage decreased slightly (and significantly in case of Glibenclamide) after both supplements were taken. Some patients no longer required insulin which is noteworthy. No change was noted in dietary intakes or Body Mass Index. A higher percentage of subjects responded positively to Brewer’s yeast chromium, which was

retained more by the body, with effects on fructosamine, triglycerides, and HDL-cholesterol maintained in some subjects when placebo followed it, and mean urinary chromium remained significantly higher than zero time mean. (p. 831, 835)

The study concluded that chromium supplementation gives better control of glucose and lipid variables while decreasing drug dosage in type 2 diabetes patients. A larger scale study however would be needed to help decide on the convenient chemical form and dosage required to achieve optimal response. (p. 831, 836) The value of the intervention would be significant in that it provides an opportunity to reduce pharmacological medications including insulin and Glibenclamide (which can cause harmful side effects) while being able to lower glucose levels more naturally through the use of brewer’s yeast. The use of a natural health supplement over a prescription medication would provide a greater overall health benefit and may even improve the overall outlook for the progression of the disease if glucose can be effectively controlled.

REFERENCES:

American Diabetes Association. Retrieved from http://www.diabetes.org/

The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. Retrieved from https://medical-dictionary.thefreedictionary.com/peripheral+neuropathy

Wilson, D.R. (2017) Acupuncture for Neuropathy. Healthline. Retrieved from https://www.healthline.com/health/acupuncture-for-neuropathy#modal-close

Zhang, C. Ma, Y. & Yan, Y. (2010) Clinical Effects of Acupuncture for Diabetic Peripheral Neuropathy. Journal of Traditional Chinese Medicine. 30(1), 13-14. doi.org/10.1016/S0254-6272(10)60003-9

Bahijiri, S.M., Mira, S.A., Mufti, A.M., Ajabnoor, M.A. (2000) The effects of inorganic chromium and

brewer’s yeast supplementation on glucose tolerance, serum lipids and drug dosage in individuals with type 2 diabetes. Saudi Medical Journal. 21(9), 831-837. Retrieved from https://www.kau.edu.sa/Files/140/Researches/49569_34265.pdf