1. Identify pathophysiology changes related to the age range and topic/disease.
Diabetes mellitus type 2 is a condition which is seen mostly in adults between age range of 30-50 years of age. It typically commences with a resistance to insulin by cells of the body, that worsens over time. To overcome this situation pancreatic beta cells produces more insulin. This resistance, and the compensating production of insulin by pancreatic beta cells, may eventually lead to beta cell failure. This beta cell failure leads to no further secretion of the endogenous insulin (McCance and Huether, 2014).
Inability of the cells to utilize insulin hormone which helps them to absorb and use glucose in metabolic process is hampered which is known as Insulin resistance. As this resistance increases the cellular uptake of glucose goes down and the glucose molecules go higher and higher in the bloodstream (McCance and Huether, 2014). If the insulin supply lessens entirely, the individual is dependent on exogenous insulin.
According to McCance and Huether (2014) the following changes occur due to constant hyperglycemia in diabetes mellitus:
- Eyes: Retinopathy and Cataracts.
- Central and Peripheral Nervous System: Neuropathy, and decreased cognition.
- Circulatory: Heart disease, cerebrovascular accident, peripheral vascular disease, and hypertension.
- Liver: Steatohepatitis and biliary disease.
- Gastrointestinal Tract: Gastroparesis.
- Kidneys: Nephropathy and chronic kidney disease.
- Hematologic System: Oxidative stress, immunosuppression, infection, and cancer.
2. Identify how the changes might be affected by the integrative therapy you have chosen (research article).
Complementary and alternative medicine (CAM) is rampantly growing for majority of medical practitioners who are currently practicing in the arena of primary care. The combination of complementary approaches with traditional medicine is referred to as integrative medicine. Cochrane has defined CAM as: ‘‘diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine’’ (Ernst, Cohen and Stone 2004).
The combination of complementary approaches with conventional allopathic treatments is often referred to as integrative medicine.
According to Birdee and Yeh (2010) 34% of population in US use different kinds of CAM modalities to treat diabetes. Their clinical review looked at different CAM modalities of treatment for diabetes.
The clinical review performed by the authors on different studies done on herbs and vegetables are as follows:
Garlic: Limited studies have been done on garlic which is used in mostly all the kitchens. The studies done on animals have suggested that it increases insulin secretion or decrease degradation. Trials on type 2 DM patients did not show any noteworthy changes in blood glucose or insulin levels.
Aloe Vera: It has been used orally for diabetes mostly in Arabian Peninsula. Studies done on type 2 DM patients have shown to decrease in fasting blood glucose levels. Due to lack of enough details on the study, the design, and the results it was thought to be inconclusive study. On the hind side the inner lining of aloe vera leaf contains anthroquinone laxative which may be unsafe for the patients.
Coccinia Indica: According to studies conducted on plant coccinia indica as mentioned in Ayurveda too for the treatment of diabetes did suggest decrease in fasting blood glucose without any adverse effects on its consumption. Another herb also mentioned in Ayurveda Gymnema Sylvestre also has shown hypoglycemic effects in animals as well as human studies. It is believed it works as an insulin secretagogue.
Momordica Charantia (bitter melon): which is a tropical vegetable grown in Asian, south America and Africa also shown a reduction on blood glucose in patients with diabetes. It is believed that this vegetable decreases hepatic glucose production, increases hepatic glycogen synthesis and possesses insulin mimetic activity. Unfortunately, most of the studies done on this vegetable did not show clinical efficiency due to absence of adequate study design.
Opuntia Streptacantha (prickly pear cactus, also known as nopal) mostly seen in Mexican cuisines have been found to have acute metabolic effects in comparison to clinical outcomes.
Ginseng: Has been found to have numerous health benefits like improved wellbeing, increase in concentration, used in treatment of cardiovascular diseases and DM 2. Ginseng does cause hypoglycemia by its action like insulin or by altering hepatic glucose metabolism.
Trigonella foenum graecum (fenugreek) used mostly in Indian cuisines has been shown to increase insulin secretion and decrease the carbohydrate absorption.
Chemical compound that is found in food like spinach, broccoli and tomatoes is known as ALA. As an antioxidant ALA has shown to diminish high levels of oxidative stress which in patient with DM2 adds to insulin resistance and leads to secondary complications of diabetes like neuropathy. Acute intravenous ALA therapy for 1-10 days has shown to improve insulin sensitivity.
Mind body therapies like yoga, Tai-chi can be form of exercises for patients with diabetes. As per current ADA guidelines any diabetic patient should perform 150 minutes /week of moderate intensity physical activity. As yoga and tai-chi are considered low-to moderate intensity exercises, these can be performed by DM 2patients. Although controlled trial studies have not shown any significant long-term improvements in glycemic control or A1C levels by yoga or tai-chi exercises.
3. Identify the possible ethical and legal issues with the chosen integrative therapy specifically for this population.
However, with the increase use of CAM, the question of efficacy and reliability arises as most of these services are provided by specialists who have not undertook the medical training. The services are not covered under the medical insurance system. There is very less research done on the use of the CAM methods. The providers of CAM are not licensed under current traditional medical system. Measurement of the results of CAM is very indecisive, multifaceted and cannot be accommodated under the standards of current research as implemented by traditional medicine as CAM is considered holistic, spiritual, psychological and mental satisfaction in comparison to the results of traditional medicine which can be proven by research.
The other legal question arises is about the truly informed consent as the interactions between the herbal medicines and conventional medicines exist, but very limited research studies are done on the interactions that are known hence a substantiate true informed consent is not achievable. For any medical practitioner to practice CAM they should familiarize with the effects of CAM, the beliefs and perceptions of their patients prior to referring them to trained CAM practitioner to ensure patient safety as some of the practices may not be in their scope of practice. So, a thorough knowledge is advisable (Ernst, Cohen and Stone, 2004).
Reference
Birdee, G., & Yeh, G. (2010). Complementary and Alternative Medicine Therapies for Diabetes: A Clinical Review. Clinical Diabetes, 28(4), 147-155.
Ernst, E., Cohen, M., & Stone, J. (2004). Ethical problems arising in evidence based complementary and alternative medicine. J Med Ethics, 30(2), 156-159.
McCance, K. L., & Huether, S. E. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Elsevier Mosby.