How can we help patients with the health outcomes that matter to them most? Many patients with cardiometabolic syndrome or diabetes want to know what they can do to preserve their vision, preserve renal function, and reduce foot problems and dental disease. The current standard of care often highlights glycemic control, but recent research indicates that this metric may not be delivering the health outcomes patients want. Going beyond a singular focus on glycemic control may be necessary to help patients attain the health outcomes they desire.
A functional medicine approach can help control glycemic indices, and it may also help reduce many related health issues. In particular, using dietary change as a first-line treatment has shown success in reversing diabetes. In Kristine Burke, MD’s, practice, not only did 75% of program participants enjoy normalization of their A1c and blood sugar numbers, many were also able to stop their diabetes medication(s). Watch her describe the diabetes reversal program:
A 2016 analysis found that diabetic retinopathy and associated vision impairment have been increasing steadily around the world, despite a focus on glycemic control.1 Renal failure and neuropathy also showed no improvements.1 This is despite the increased focus on glycemic control, now supported by a variety of clinical guidelines.2 The prevalence of diabetes is estimated to increase to 629 million by 2045.3
The focus on glycemic control is costly and is generally not supported by the literature. A joint Canadian-US study estimated the annual cost of hypoglycemia resulting from tight glycemic control in older adults was $65,497,849 in Canada and $509,214,473 in the US.2 In a review, Mayo Clinic researchers found that tight glycemic control was not supported by research; it did not lower the risk of progression to dialysis, renal transplant, blindness, neuropathy, all-cause mortality, or stroke.2 Further, tight glycemic control in the frail elderly can actually lead to hypoglycemia and dementia4 and can create as well as treat episodes of neuropathy.5 While medications can normalize glucose numbers, this approach fails to stem the tide of diabetes complications. Research suggests that diet-based approaches have greater success, including omega-3 fatty acid interventions that research suggests can successfully reduce retinopathy.6
At least for some patients, exercise and nutrition interventions may outperform medications. In a 2020 study published in The Lancet, researchers found that intensive lifestyle intervention led to significant weight loss at 12 months, and was associated with diabetes remission in over 60% of participants and normoglycaemia in over 30% of participants.7 Study participants were aged 18-50 years, had a short diabetes duration (~3 years), and had a BMI of 27.0 kg/m2 or more. The intensive lifestyle intervention comprised a total diet replacement phase, in which participants were given formula low-energy diet meal replacement products followed by gradual food reintroduction combined with physical activity support, and a weight-loss maintenance phase, involving structured lifestyle support. The authors say that the provision of this lifestyle intervention could allow a large proportion of young individuals with early diabetes to achieve improvements in key cardiometabolic outcomes, with potential long-term benefits for health and well-being.7
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