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Americans are flocking to complementary and alternative medicine (CAM). Depending on how the terms are defined, between 10% and 50% of Americans report using some form of complementary or alternative medicine.
According to an oft-cited landmark study by Harvard researcher David Eisenberg, MD, Americans make more visits to CAM practitioners than they do to primary care physicians, and spend more out-of-pocket for CAM remedies than for conventional medical care.
Among the most popular forms of CAM are acupuncture, homeopathy, chiropractic, nutritional and herbal remedies, biofeedback and relaxation therapy, and massage therapy.
"These are modalities and therapies that are unproven," said Michael J. Quon, MD, chief of the diabetes unit of the National Institutes of Health National Center for Complementary and Alternative Medicine (NCCAM), at the recent American Diabetes Association's (ADA's) Scientific Sessions in Orlando, Fla.
"Despite great interest and widespread usage, it's been quite difficult to apply rigorous methodology to some of these practices," Quon said.
Surveys show that interest in CAM among those with diabetes is much greater than in the general population. In a follow-up survey, Eisenberg and colleagues discovered that people with diabetes are more than twice as likely as healthy persons to use CAM approaches, and people with diabetes aged 65 or older are about three times as likely as younger patients to use CAM.
While many patients are reluctant to bring up CAM with their physician, Eisenberg's survey revealed that 57% of patients talk it over with their provider. Nearly half of patients—43%—report being referred to CAM by their primary care physician.
Although some forms of CAM are unlikely to cause harm, such as massage therapy or biofeedback, others have considerable potential to result in untoward events. Remedies commonly used for the treatment of diabetes and related conditions include aloe, cinnamon, vitamin C, glucosamine, chromium, green tea, ginseng, and carnitine.
Many physicians are skeptical that CAM remedies are helpful for those with diabetes. "There's very little data about whether any of these actually work," said Michelle Magee, MD, director of the MedStar Diabetes Institute at Washington Hospital Center. "I don't think there's clear evidence one way or another. So many people are taking big buckets of this stuff."
Herbal remedies in general have not been shown to improve the control of glucose, and in some cases can result in adverse effects. It's very important for clinicians to ask patients with diabetes about their use of CAM, particularly herbal and nutritional remedies. Some herbs, such as ginseng, can interact with many drugs and cause severe side effects, according to University of Utah pharmacist Laura Shane-McWhorter.
Glucosamine, an amino sugar often taken with chondroitin as a remedy for osteoarthritis, "may make insulin resistance worse, pushing obese patients into diabetes," said Quon.
At a session of the ADA meeting, several researchers presented results suggesting that remedies considered alternative may actually have beneficial therapeutic effects for people with diabetes.
The trace element chromium, for example, has long been recognized for its role in metabolism. A deficiency of chromium can result in insulin resistance, increased blood glucose and lipids, and greater body fat mass, according to Richard Anderson, of the United States Department of Agriculture's Human Nutrition Research Center in Beltsville, Md.
Studies presented at the conference show that daily nutritional supplementation with chromium significantly reduces fasting blood glucose levels in chromium-deficient people with type 2 diabetes, and also improves blood lipids and cardiovascular risk factors. "We're convinced that there's something to this," Anderson said.
Most importantly, chromium picolinate appears to have a very favorable safety profile, even at doses thousands of times greater than recommended. "There have been no documented effects from chromium in any of the studies out there," said Anderson. "Of all the nutrients we looked at, chromium is certainly one of the safest supplements for reducing risk factors associated with diabetes and cardiovascular disease."
Joseph Evans, of the Medical Research Institute, described clinical studies with alpha-lipoic acid, a compound with powerful antioxidant and anti-inflammatory effects. Supplementation with 600 to 1,800 mg/day of alpha-lipoic acid "shows beneficial effects for those with peripheral neuropathy," said Evans.
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Research suggests that alphalipoic acid protects the body against oxidative stress–related insulin resistance, improving insulin sensitivity in patients with type 2 diabetes. Like chromium, alphalipoic acid appears to have a good safety profile, according to Evans. Critics suggest that not enough is known about the activity of alphalipoic acid to justify its routine use, since clinical studies with the compound typically involve intravenous administration while the product is marketed in a sustained release oral formulation.
Nonetheless, alpha-lipoic acid "represents a potentially new adjunctive antidiabetic treatment with anti-inflammatory and insulin-sensitizing properties," Evans said.
For patients who venture into CAM remedies, Shane-McWhorter offers these suggestions:
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