Management of a patient with insulin-dependent diabetes mellitus learning biofeedback-assisted relaxation

Comparisons of health education, group medical care, and collaborative health care for controlling diabetes

INTRODUCTION

This article presents early-phase clinical investigations into how to care for people with diabetes mellitus (DM) in an outpatient setting, focusing on efforts at improving care for Native Americans using conventional and nonconventional interventions-in particular, whether engaging people with DM using culturally specific and spiritual methods were more effective in reaching several DM management goals than conventional methods alone. This outreach may be seen as an example of delivering culturally competent medical care, a prime objective of family medicine.

METHODS

In a three-year, serial process, three interventions included: diabetic health education, group medical care for diabetes, and shared collaborative care, which included medical, psychological, and spiritual care provided simultaneously.

RESULTS

In all clinical outcome data-multiple measures of glucose control-statistically significant differences were found between shared, collaborative care and group medical care, and also between these and standard health education and conventional care.

DISCUSSION

Several potential explanations are offered, with discussion, for how shared, collaborative care can be more helpful than group care or individualized care alone, including: stress reduction, increased social support, producing more positive health beliefs, and acting as a kind of naturalistic biofeedback.

Systematic review of herbs and dietary supplements for glycemic control in diabetes

OBJECTIVE

To conduct a systematic review of the published literature on the efficacy and safety of herbal therapies and vitamin/mineral supplements for glucose control in patients with diabetes.

RESEARCH DESIGN AND METHODS

We conducted an electronic literature search of MEDLINE, OLDMEDLINE, Cochrane Library Database, and HealthSTAR, from database inception to May 2002, in addition to performing hand searches and consulting with experts in the field. Available clinical studies published in the English language that used human participants and examined glycemic control were included. Data were extracted in a standardized manner, and two independent investigators assessed methodological quality of randomized controlled trials using the Jadad scale.

RESULTS

A total of 108 trials examining 36 herbs (single or in combination) and 9 vitamin/mineral supplements, involving 4,565 patients with diabetes or impaired glucose tolerance, met the inclusion criteria and were analyzed. There were 58 controlled clinical trials involving individuals with diabetes or impaired glucose tolerance (42 randomized and 16 nonrandomized trials). Most studies involved patients with type 2 diabetes. Heterogeneity and the small number of studies per supplement precluded formal meta-analyses. Of these 58 trials, the direction of the evidence for improved glucose control was positive in 76% (44 of 58). Very few adverse effects were reported.

CONCLUSIONS

There is still insufficient evidence to draw definitive conclusions about the efficacy of individual herbs and supplements for diabetes; however, they appear to be generally safe. The available data suggest that several supplements may warrant further study. The best evidence for efficacy from adequately designed randomized controlled trials (RCTs) is available for Coccinia indica and American ginseng. Chromium has been the most widely studied supplement. Other supplements with positive preliminary results include Gymnema sylvestre, Aloe vera, vanadium, Momordica charantia, and nopal.