ACCORDING TO THE CENTERS FOR DISEASE CONTROL AND PREVENTION CDC, one out of three Americans will be diagnosed with diabetes by 2050. Already, 29 million people have been diagnosed with the disease. In 2012, diabetes cases, of which 90 percent were type 2, cost the U.S. health care industry about $245 billion. As chiropractic physicians, our profession can greatly affect the health of society by treating two of the most costly diseases in America – spinal pain, specifically lower back pain and type 2 diabetes. The conservative-first approach by doctors of chiropractic (DCs) to disease management and clinical treatment produces great outcomes.
NIH Trial on Prediabetes
In 2002, NIH published the results of its landmark trial Diabetes Prevention Program, which was conducted over three years, in the New England Journal of Medicine. There were 27 test sites across America where researchers divided 3,000 overweight subjects with prediabetes into three groups; one group was counseled in lifestyle changes, one group was given metformin and one group was given a placebo.1
The test subjects who were given instructions in diet and exercise reduced their risk of developing diabetes by 58 percent overall, with the subgroup of subjects 60 years of age or older reducing their risk by 71 percent. The test subjects who took metformin reduced their risk of diabetes by only 31 percent, about half as successful as the test subjects who changed their lifestyles. The researchers of this study followed up with the test subjects about 15 years later and published in November 2015 that 27 percent fewer subjects in the lifestyle change group ended up with type 2 diabetes than the metformin group.2
It is still unknown whether diet and exercise can completely stop or reverse type 2 diabetes. Several studies indicate lifestyle changes can lower diabetic symptoms and, more important, reduce the use of medications.
A Devastating Disease
As physicians, we see the clinical devastation that diabetes has on our patients. They do not respond as well to treatment. Their increased body mass index (BMI) increases stress on their weightbearing joints, accelerating the degenerative changes in these articulations. Insulin-causing metabolic diseases affect other organs, especially the thyroid and adrenal glands, which in turn, causes cascading endocrine symptoms. Viscero-somatic reflexes cause facilitation of spinal segments that cause “alterations in muscle tone that may result in stiffness, spasms and pain.”3 Viscero-somatic reflexes from the pancreas may facilitate thoracic segments V-IX.4
These are our patients who get good relief with spinal manipulation but complain that the relief is short-lived. If DCs are true to our holistic and conservative-first approach to disease management, DCs must treat our diabetic patients with more than only manual medicine. These patients look to us for their health care needs and our intervention to prevent CAD (cerebral arterial disease), metabolic syndrome, CVD (cardiovascular disease), CKD (chronic kidney disease), blindness, liver disease and neuropathies to name a few.
With the shortage of primary care providers, it is our duty as portal-of-entry physicians to help our patients with this disease that is in the United States in epidemic proportions.
1) Diabetes Prevention Program Research Group. Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. N Engl J Med 2002; 346:393-403 Feb. 7, 2002. DOI: 10.1056/NEJMoa012512.
2) Diabetes Prevention Program Research Group. Longterm effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study. The Lancet Diabetes & Endicrinology, Vol 3, No. 11, p.866-876, Nov. 2015.
3) Michigan State University College of Osteopathic Medicine, CME On Line, Principles of Manual Medicine – Facilitated Segment – viscero-somatic reflexes; hal.bim. msu.edu.
4) Pottenger; Symptoms of Visceral Disease 6th Edition; Mosby Co.; pgs.286-287
Glycemic and Renal Markers
SINCE CHIROPRACTIC PHYSICIANS PRESCRIBE dietary and exercise programs for prediabetic and diabetic patients, it’s important to have markers to start a baseline and follow to see if clinical treatment is effective. The standard of care for following these patients is changing with advances in technology, and it is now becoming common to use several glycemic and renal markers.
Glycemic Markers: serum, plasma or whole blood.1
Adiponectin – serum
PRIMARY PURPOSE: It is a protein secreted by adipocytes that becomes dysfunctional in patients who are obese.
RISK ASSOCIATIONS: Low levels of adiponectin in overweight patients translated into a three-fold risk for metabolic syndrome, nine-fold risk for developing diabetes and a two-fold risk of developing CAD.
Glycated Albumin –
PRIMARY PURPOSE: A marker of glucose control over a one-month period. It is commonly used to diagnose specially helpful in patients with blood disorders where HbA1c is unable to be performed.
RISK ASSOCIATIONS: Elevated levels of glycated albumin are associated with poor diabetes control that can lead to increased risk of heart disease, blindness, kidney failure and amputations due to peripheral vascular neuropathies.
GlycoMark ®– serum
PRIMARY PURPOSE: It measures 1,5-anhydroglucitol, which is a naturally occurring monosaccharide that reflects peak glucose levels over one to two weeks. In patients with an HbA1c at or near goal (A1C < 8.0), GlycoMark® detects elevated post-meal glucose spikes that are not detectable by the HbA1c test.
RISK ASSOCIATIONS: Glucose spikes are associated with the cardiovascular complications of diabetes.
HbA1c – whole blood
PRIMARY PURPOSE: It is a marker of glucose control over a two to three month period. It is commonly used to diagnose different forms of diabetes or monitor blood sugar control.
RISK ASSOCIATIONS: Elevated levels of HbA1c are associated with poor diabetes control that can lead to increased risk of heart disease, blindness, kidney failure and amputations due to peripheral vascular neuropathies.
Insulin – serum
PRIMARY PURPOSE: It is a hormone necessary for energy regulation and glucose metabolism.
RISK ASSOCIATIONS: Elevated levels over time lead to a decrease in insulin sensitivity associated with impaired fasting glucose and impaired glucose tolerance.
Oxidized LDL (OxLDL) – plasma
PRIMARY PURPOSE: LDL in a normal patient resists oxidation, but in patients with metabolic syndrome, LDL may become oxidized and this increases the risk for CAD.
RISK ASSOCIATIONS: Patients with a high level of OxLDL are 3.5 times more likely to develop metabolic syndrome in the next five years. Increased OxLDL levels are associated with the presence of coronary artery disease. In healthy middle-aged men, high OxLDL levels are associated with a four times greater risk of developing coronary heart disease.
Pre-Diabetes Risk Assessment (HOMA-IR) – serum
PRIMARY PURPOSE: It is a method for assessing beta cell function and insulin resistance (IR) from basal glucose and insulin concentrations.
RISK ASSOCIATIONS: Changes in HOMA-IR are an early indication of development of peripheral vascular insulin resistance. This occurs well before there are significant changes in one’s fasting blood glucose or HbA1c levels. Loss of insulin sensitivity can lead to a plethora of metabolic disorders.
Cystatin C – serum
PRIMARY PURPOSE: It is a biomarker for kidney function that is superior to serum creatinine for estimating glomerular filtration rate (GFR). Unlike creatinine, cystatin C is capable of detecting mild decreases in GFR and is minimally affected by age, muscle mass, gender and race.
RISK ASSOCIATIONS: Cystatin C is a prognostic biomarker of CV events, CHF, CVA, PAD and metabolic syndrome that can cause mortality even in the absence of established renal disease.
1) Athrotech Diagnostic Labs: www.Athrotech.com
Robert C. Jones, DC, APC, graduated from Palmer College Davenport in 1989. Dr. Jones spent most of his career in a multidisciplinary integrative family practice. He believes in the full integration of chiropractic medicine with mainstream health care in a manner that retains the conservative-first approach to clinical practice but allows for scope expansion through education. Dr. Jones serves on the ACA Board of Governors and is a board of trustee member to the University of the Western States and the immediate past president of the New Mexico Chiropractic Association.
Tobi Jeurink, DC, DABCI, FICPA, graduated in 2001 from Cleveland Chiropractic College. She is president of the American Board of Chiropractic Internists testing committee. She is the Kansas delegate on the ACA HOD and serves on the Medicare Committee. She serves on a multidisciplinary pain committee at KU Med. She is an instructor in the Diagnostic Sciences Department at Cleveland Chiropractic College. She owns Jeurink Family Chiropractic and Wellness Center in Gardner, Kan.