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Diabetes Mellitus: Non-Pharmacological Therapy!

 

NON PHARMACOLOGICAL THERAPY 

  1. MNT
  2. Glycemic Index
  3. Dietary supplements
  4. Weight measurements
  5. Physical Activity
  6. Psychological assessment
  7. Immunizations

2.GLYCEMIC INDEX

"The Glycemic index of a carbohydrate containing food is determined by comparing the glucose excursions after consuming 30g of test food with glucose excursions after consuming 50g of reference food (white bread)"

Glycemic Index= Blood glucose area under the curve (3hr) for test food / Blood glucose area under the curve (3hr) for reference food

  • Low glycemic index foods have value of 53 or less and include many fruits, vegetables, grainy breads, legumes, etc.

  • High glycemic index foods have value of 70 or greater and include baked potatoes, white bread, etc.

3.DIETARY SUPPLEMENTS

  • Patients may seek and use dietary supplements in the treatment of diabetes. 
  • Remember, despite the popular notion, there is no "diabetes specific diet".
  • Data from randomized controlled trials seem to support the efficacy of Coccina indica and American ginseng for improving glucose control.
  • Other studies include supplements such as Chromium, Gymnema sylvester, Aloe vera, Vanadium, Momordica charantia, Nopal, etc.


4.WEIGHT MEASUREMENTS

  • Moderate weight loss in patients with T2DM have shown to decrease cardiovascular diseases as well as preventing or delaying the onset of DM in those at high risk.
  • The recommended primary approach to reduce the weight is Therapeutic lifestyle change (TLC) which indicates a 7% reduction in body weight and an increase in physical activity. A slow but progressive weight loss of 0.45 to 0.9 kg per week is preferred.
  • A general rule for weight loss diet is that they should supply at least 1000 to 1200 kcal/day for women and 1200 to 1600 kcal/day for men.
  • Gastric reduction surgeries when used as a part of comprehensive approach to weight loss are recommended for considerations in patients with T2DM and a BMI that exceeds /m2.

5.PHYSICAL ACTIVITY

  • Recommended physical activity goals for patients with T2 DM include 150 minutes per week of moderate to vigorous aerobic exercise spread out during at least 3 days of the week.
  • Walking, Swimming, cycling Gardening and usual house-cleaning tasks are good exercises that could be encouraged.

6.PSYCHOLOGICAL ASSESSMENT

  • Clinicians should incorporate psychological assessment and treatment in routine care.
  • The ADA guidelines recommend ongoing psychological screening.
  • Patients demonstrating poor self-management should be screened for diabetes related distress, depression, anxiety, eating disorder and cognitive impairment.

7.IMMUNIZATIONS

  • Early Influenza vaccinations commonly called flu shots, are recommended for all patients with DM of 6 months of age or older.
  • Pneumococcal vaccinations are recommended for patients with DM who are 2years of age or older as a one-time vaccination. 
  • Revaccination is also indicated in patients with Nephrotic syndrome or chronic renal diseases and transplantation.
  • Hepatitis B vaccine series should be administered in patients according to the recommendations of Center of Disease Control and Prevention.
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