November is Diabetes Awareness Month

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As we recognize Diabetes Awareness Month, it’s important to highlight that 30% of Canadians are currently living with diabetes or prediabetes. Among these individuals, 10% have been formally diagnosed with diabetes, while the remainder comprises those with undiagnosed type 2 diabetes and prediabetes. An astounding 90-95% of all diabetes cases are classified as type 2 diabetes.[i] Naturopathic and integrative medicine approaches focus on treating the whole person, addressing the underlying causes, and striving to prevent disease progression and complications of diabetes.

This article explores the widespread impact of diabetes, covering alarming recent statistics, adverse effects, and its contribution to polypharmacy. Findings from recent meta-analyses and clinical trials emphasize the role of natural therapies in supporting individuals with pre-diabetes, diabetes, and diabetes-related complications.

The Diabetes Epidemic in Canada – How Widespread is the Impact?[ii],[iii],[iv]:

  • Diabetes is a rising health concern in Canada and was the seventh leading cause of death in the country in 2022, accounting for around 2.3 percent of all deaths that year.
  • Diabetes contributes to 30% of strokes, 40% of heart attacks, 50% of kidney failure requiring dialysis, 70% of all non-traumatic leg and foot amputations, and is the leading cause of blindness in Canadian adults.
  • Diabetes has been consistently associated with increased risk of several cancers, with the highest risk for liver, pancreatic, colorectal, endometrial, breast and bladder cancer. It remains unclear whether this association is direct (i.e. due to hyperglycemia), whether diabetes is a marker of underlying factors that triggers cancer risk (i.e. insulin resistance and hyperinsulinemia), or whether this cancer-diabetes association is indirect (i.e. due to common risk factors, such as obesity).
  • Diabetes can reduce lifespan by five to fifteen years.
  • Individuals with depression have a 40% to 60% increased risk of developing type 2 diabetes. Thirty percent of people with diabetes report having depressive symptoms.
  • Diabetes is a major contributor to polypharmacy. In a study of individuals aged 66–75 with diabetes, nearly 90% used five or more medications, and 59% used ten or more. Common drugs included antidiabetic, cardiovascular, CNS medications (e.g., antidepressants), and proton pump inhibitors.
  • Indigenous populations in Canada are disproportionately impacted, with diabetes rates that are 3 to 5 times higher than those seen in non-Indigenous population.
  • The prevalence of type 2 diabetes in the lowest income group is 4.14 times higher than in the highest income group.

Recent Meta-Analysis and Clinical Trials:

  1. Lifestyle and Dietary Modifications: Foundational to Prevention

    • In a pilot non-randomized pre-post intervention design, forty-five adults with or at risk for prediabetes participated in 12-weekly 90-min workshops emphasizing the health benefits of a naturopathic whole foods diet and including collective meal preparation and communal dining. Decreases in blood glucose, hs-CRP, triglycerides, cholesterol, low-density lipoprotein, very-low-density lipoprotein, and HbA1c from baseline were observed at 12-month follow-up. Both insulin and high-density lipoprotein were decreased from baseline and 12-week levels at the 6-month follow-up but increased from all earlier levels at 12 months (all p < 0.0001).[v]
    • A systematic review and meta-analysis of forty-six randomized controlled trials totaling 2130 adults with type 2 diabetes demonstrated that resistance training significantly reduced hemoglobin A1C (HbA1c) (MD -0.50% [95% CI, -0.67, -0.34 %], p < .00,001) and fasting glucose (MD -12.03 mg/dl [95% CI, -19.36, -4.69 mg/dl], p = .001).
    • In a 6-week, single-center, randomized, parallel-group study 58 women with type 2 diabetes were assigned to either the aerobic training group or the aerobic exercise combined with slow deep breathing and mindfulness meditation. The aerobic training with slow, deep breathing exercises and mindfulness meditation group showed significantly lower levels of fasting blood glucose (FBG) (p = 0.001) and cortisol levels (p = 0.01) than the aerobic training group.[vi]

        2. Nutritional Supplementation – Impact on Glycemic Indices, Inflammatory Biomarkers and Complications of Diabetes


      • Berberine: An umbrella meta-analysis of randomized controlled trials found that berberine supplementation was statistically significant in reducing FBG (ESWMD: -0.77; 95% CI: -0.90 to -0.63, and ESSMD: -0.65; 95% CI: -0.83 to -0.47), HbA1C (ESWMD: -0.57; 95% CI: -0.68 to -0.46), homeostasis model assessment for insulin resistance (HOMA-IR) (ESWMD: -1.04; 95% CI: -1.66 to -0.42, and ESSMD: -0.71; 95% CI: -0.97 to -0.46), insulin (ESWMD: -1.00; 95% CI: -1.70 to -0.30, and ESSMD: -0.63; 95% CI: -0.94 to -0.32), interleukin (IL)-6 (ESSMD: -1.23; 95% CI: -1.61 to -0.85), tumor necrosis factor-α (TNF-α) (ESSMD: -1.04; 95% CI: -1.28 to -0.79), and C-reactive protein (CRP) (ESWMD: -0.62; 95% CI: -0.74 to -0.50, and ESSMD: -1.70; 95% CI: -2.21 to -1.19).[vii]
      • Resveratrol: A systematic review and meta-analysis including thirty experimental studies that investigated the effects of resveratrol supplementation for diabetes treatment or prevention found a significant effect on the reduction of insulin resistance [SMD: -0.34; CI 95%: -0.64, -0.04; p = 0.01; I2 = 70%] and glycated hemoglobin [SMD: -0.64; CI 95%: -1.22, -0.07; p = 0.01; I2 = 90%]. For fasting blood glucose, the results were significant only for individuals with diabetes [SMD: -0.85; CI 95%: -1.49, -0.21; p = 0.01; I2 = 90%].[viii] In a meta-analysis of 35 RCTs to assess the effect of resveratrol on C-reactive protein in inflammatory conditions, resveratrol supplementation significantly reduced the hs-CRP (MWD = -0.40 mg/L; 95% CI: -0.70 to -0.09 mg/L; p = .01) and CRP (MWD = -0.31 mg/L; 95% CI: -0.47 to -0.15 mg/L; p < .001) levels in serum. Subgroup analysis showed greater benefits when supplementation took place for ≥ 10 weeks with ≥ 500 mg/day. [ix]
      • Probiotics: A grade-assessed systematic review and dose-response meta-analysis of thirty-two randomized controlled trials found that supplementation with probiotics  significantly (p <0.05) improved indices of glycemic control: FBG (WMD: -13.27 mg/dl; 95 % CI: -18.31, -8.22), HbA1c (WMD: -0.44 %; 95 % CI: -0.59, -0.28), insulin (WMD: -1.33 μIU/ml; 95 % CI: -2.57, -0.08), and HOMA-IR (WMD: -0.95; 95 % CI: -1.71, -0.18). Dose-response analysis revealed that increased duration of intervention results in a larger reduction in FBG.[x]
      • Alpha-lipoic acid: A multi-center prospective randomized controlled study investigated the effect of 600 mg alpha-lipoic acid once daily for 6 months in diabetic patients on hemodialysis. The control group (n=30) received Epoetin-alpha plus insulin therapy, and the treatment group (n=30) received the same treatment plus ALA. ALA group showed significant reductions in serum levels of hs-CRP, TNF-α, 8-OHdG (p<0.001), urea, and BUN (p=0.029) with significant elevations in Hb concentration (p<0.001), serum iron (p=0.037) and transferrin saturation (p<0.001). ALA group showed a significant decline in FBG (p=0.004), HbA1c (p<0.001), fructosamine (p=0.005), erythropoietin resistance index (p<0.001), weekly doses, and the weekly cost of Epoetin-alpha, and the total cost (p<0.001). The ALA group showed significantly lower mean value of ankle-brachial index as compared to the control group (1.0 ± 0.18 vs.0.94 ± 0.04; p=0.045).[xi]
      • Fenugreek: A systematic review and meta-analysis of nineteen clinical trials, including a total of 1612 participants (807 intervention, 805 control) examining the effect of fenugreek on type 2 diabetes indicated a significant impact of fenugreek supplementation on lowering fasting plasma glucose (WMD: 20.32 mg/dl; 95 % CI: 26.65 to -13.99), HbA1c (WMD: 0.54 %; 95 % CI: 0.80 to -0.28), HOMA-IR) (WMD: 0.36; 95 % CI: 0.67 to -0.05, total cholesterol (WMD: 33.10 mg/dL; 95 % CI: 64.31 to -1.88), LDL-C (WMD: 29.14 mg/dL; 95 % CI: 55.45 to -2.83), BMI (WMD: 0.73 kg/m2; 95 % CI: 1.40 to -0.07), and increasing HDL-C (WMD: 5.68 mg/dL; 95 % CI: 3.51 to 7.85).[xii]
      • Benfotiamine: A double blind, placebo-controlled, randomized trial investigated the effect of benfotiamine in 165 patients with symmetrical, distal diabetic neuropathy. [xiii] After 6 weeks of treatment, the Neuropathy Symptom Score (NSS) differed significantly between the treatment groups (p=0.033) in the per protocol population. The improvement was greater at the higher benfotiamine dose and with increased treatment duration. The randomized, double-blind, placebo controlled BOND study is currently investigating the effects of treatment with benfotiamine compared with placebo in participants with type 2 diabetes and mild to moderate symptomatic diabetic sensorimotor polyneuropathy.[xiv]

    Conclusion

    As we observe Diabetes Awareness Month, it is important to acknowledge the significant contributions of naturopathic and integrative medicine in addressing the extensive impacts of diabetes. By emphasizing lifestyle interventions, dietary modifications, nutritional supplementation, stress management, and personalized care, we can enhance the overall wellbeing of patients. Moreover, ongoing clinical research continues to shed light on the effectiveness of natural medicine approaches, offering validation of current therapies and rationale for innovative treatments in the fight against diabetes.

    [i] https://www.diabetes.ca/advocacy—policies/advocacy-reports/national-and-provincial-backgrounders/diabetes-in-canada

    [ii] Lau DCW, Shaw E, Farris MS, McMullen S, Brar S, Cowling T, Chatterjee S, Quansah K, Kyaw MH, Girard LP. Prevalence of Adult Type 2 Diabetes Mellitus and Related Complications in Alberta, Canada: A Retrospective, Observational Study Using Administrative Data. Can J Diabetes. 2024 Apr;48(3):155-162.e8. doi: 10.1016/j.jcjd.2023.12.004. Epub 2023 Dec 21. PMID: 38135113.

    [iii] https://diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-1#panel-tab_FullText

    [iv] Gagnon ME, Sirois C, Simard M, Plante C. Polypharmacy and Pharmacological Treatment of Diabetes in Older Individuals: A Population-Based Study in Quebec, Canada. Pharmacy (Basel). 2019 Dec 1;7(4):161. doi: 10.3390/pharmacy7040161. PMID: 31805662; PMCID: PMC6958384.

    [v] Tippens, Kimberly M et al. “Impact of a Short-Term Naturopathic Whole-Foods-Based Nutrition Education Intervention on Dietary Behavior and Diabetes Risk Markers: A Pilot Study.” Journal of alternative and complementary medicine (New York, N.Y.) vol. 25,2 (2019): 234-240. doi:10.1089/acm.2018.0025

    [vi] Obaya, Hany Ezzat et al. “Effect of aerobic exercise, slow deep breathing and mindfulness meditation on cortisol and glucose levels in women with type 2 diabetes mellitus: a randomized controlled trial.” Frontiers in physiology vol. 14 1186546. 13 Jul. 2023, doi:10.3389/fphys.2023.1186546

    [vii] Nazari, Ahmad et al. “The Effect of Berberine Supplementation on Glycemic Control and Inflammatory Biomarkers in Metabolic Disorders: An Umbrella Meta-analysis of Randomized Controlled Trials.” Clinical therapeutics vol. 46,2 (2024): e64-e72. doi:10.1016/j.clinthera.2023.10.019

    [viii] Delpino, Felipe Mendes, and Lílian Munhoz Figueiredo. “Resveratrol supplementation and type 2 diabetes: a systematic review and meta-analysis.” Critical reviews in food science and nutrition vol. 62,16 (2022): 4465-4480. doi:10.1080/10408398.2021.1875980

    [ix] Gorabi, Armita Mahdavi et al. “Effect of resveratrol on C-reactive protein: An updated meta-analysis of randomized controlled trials.” Phytotherapy research : PTR vol. 35,12 (2021): 6754-6767. doi:10.1002/ptr.7262

    [x] Hejazi, Najmeh et al. “Clinical nutrition ESPEN, vol. 64 133-143. 28 Sep. 2024, doi:10.1016/j.clnesp.2024.09.014

    [xi] Abdel Hamid, D Z et al. “Alpha-lipoic acid improved anemia, erythropoietin resistance, maintained glycemic control, and reduced cardiovascular risk in diabetic patients on hemodialysis: a multi-center prospective randomized controlled study.” European review for medical and pharmacological sciences vol. 26,7 (2022): 2313-2329. doi:10.26355/eurrev_202204_28461

    [xii] Vajdi, Mahdi et al. “Therapeutic effect of fenugreek supplementation on type 2 diabetes mellitus: A systematic review and meta-analysis of clinical trials.” Heliyon vol. 10,17 e36649. 22 Aug. 2024, doi:10.1016/j.heliyon.2024.e36649

    [xiii] Stracke, H et al. “Benfotiamine in diabetic polyneuropathy (BENDIP): results of a randomised, double blind, placebo-controlled clinical study.” Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association vol. 116,10 (2008): 600-5. doi:10.1055/s-2008-1065351

    [xiv] Bönhof, Gidon J et al. “BOND study: a randomised double-blind, placebo-controlled trial over 12 months to assess the effects of benfotiamine on morphometric, neurophysiological and clinical measures in patients with type 2 diabetes with symptomatic polyneuropathy.” BMJ open vol. 12,2 e057142. 3 Feb. 2022, doi:10.1136/bmjopen-2021-057142

     

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