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The AADE Living Legend Award, established in 2008, recognizes outstanding contributions to diabetes education; past recipients have included Dr. Adam: When you look at the field of diabetes, what do you think are some big changes that you would like to see?
Adam: So when you look at the diabetes landscape today, what do you think worries you the most?
Adam: What do you think are some of the most effective stress management techniques that you emphasize with patients? Adam: At the AADE annual meeting in 2010, I remember being fascinated by a panel discussion on living with advanced duration diabetes. After assessing which approach might be most appropriate, I’d basically hook up the machine and say, “You have two minutes with the music and you can pick the type of music that you think is most relaxing to you.” Or if you picked the imagery, you would listen to the tape that’s most relaxing and we’d allow the machine to lead us. One thing that’s missing is information on the different remedies that actually lower blood sugar, other than supplements. Adam: Much of your career has focused on complementary and alternative approaches like stress management or relaxation techniques. Of course, a person with diabetes must be extra careful to watch how their blood sugars respond.
Adam: Turning to a slightly different topic, what else do you think we could be doing on the diabetes prevention front?
With obesity being such a problem, it’s important to start with kids, as well parents and other adults. Adam: What can an organization like the American Association of Diabetes Educators (AADE) do even better?
This way, people could know if their physician was certified specifically in managing diabetes.
As clinics do this, they do better overall on their average A1c, if you want to use that as a marker.
Adam: What are some good sources for more information on complementary and alternative medicine?
Our mission is to help individuals better understand their diabetes and to make our readers happier & healthier.
Our mission is to help individuals better understand their diabetes and to make our readers happier and healthier. Objectives: Diabetes mellitus (DM) and hypertension (HT) are chronic disorders with which mental disorders may coexist and for which patients may resort to alternative medicine use.
But after the invention of a new device, it is possible that patients get rid of the pain of injections. FDA approval of new insulin is released with a warning, lung diseases, such as (Asthma), People who suffer from severe cough shower never use it.
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Diana Guthrie, the 2011 winner of the AADE Living Legend Award, and a strong proponent of holistic, complementary, and alternative approaches to diabetes management. Guthrie: From my understanding, somebody submits your name and qualifications and then the board votes on it.
But, we have long known how beloved you are in the diabetes community, and that you really seem to understand patients, families, technologies, and therapies – so we’re sure the award didn’t come as a surprise to many! Guthrie: My work with medicine and children and what I have learned from parents and kids themselves.
What do you think has been the most striking change that you have seen over that time period?
Guthrie: Probably the medicines that allow for increased flexibility and the ability to maintain diabetes control and enhance the patient’s quality of life.
Guthrie: I’ll be very interested to see all of those things being studied in type 1 diabetes.
Guthrie: One of the most interesting things is how controlled breathing works as a stress management tool.
Many of the panelists with long-standing diabetes recommended stress reduction techniques such as yoga, tai chi, and mindfulness meditation.
Guthrie: It is a mechanism that gives information that is not readily available and indicates increased relaxation.
What would you recommend I incorporate into my daily routine to improve my health and diabetes management?
Guthrie: After doing a careful assessment and getting a background history, I would find things that you are interested in – things that you would be willing to attempt and would help you on the diabetes management side, along with the relaxation practices that you were choosing. Then it’s just practice – it usually takes kids four to six weeks and adults six to ten weeks to really learn these practices and call on them at will.
Besides slow breathing, calming music, and imagery, are there any other relaxation techniques?
Guthrie: When a patient has a craving for sweets, I may tell them about gymnema sylvestre – this is an herb that makes sweets not taste as good. Guthrie: There has been a fair amount of research on fenugreek, and it seems quite acceptable and certainly useful. Do you find that there is skepticism within the medical community, or even from patients themselves saying, “This won’t work for me” or “This is not scientific” or “There is not a lot of research.” How do you address this? People were throwing that at patients right and left, and then we found out that at certain levels, the antioxidant factors become pro-oxidant factors. But for the average endocrinologist or nurse educator, these methods probably aren’t in their top three or five priorities, right?
Guthrie: I think that that’s true, and their hesitation in doing this is quite puzzling to me. I tell them their blood sugars are like biofeedback: they can tell whether a specific food is going to raise their blood sugar too high and too fast, or if that particular modality is going to be more useful for them. The College of Endocrinology is doing a wonderful job, as is the American Diabetes Association (ADA) and AADE.
To me, that marker also says patients are educated, they are handling some of the stresses in their life, they know the resources, and they have ongoing phone support 24 hours a day, 7 days a week. Mental disorders frequency alternative and complementary medicine usage among patients with hypertension and type 2 diabetes mellitus. These disorders result in not only morbidity and mortality, but also severe economic losses. Are psychopathological features relevant predictors of glucose control in patients with type 2 diabetes? Determination of psychiatric disorders among outpatients who admitted to internal medicine clinic in a University Hospital.
The prevalence and pattern of complementary and alternative medicine use in individuals with diabetes. Gender, quality of life, and mental disorders in primary care: Results from the PRIME-MD 1000 study.
Comorbid anxiety disorder and the functioning and well-being of chronically ill patients of general medical providers. Depression and diabetes: A large population-based study of sociodemographic, lifestyle, and clinical factors associated with depression in type 1 and type 2 diabetes. A quantitative review of prospective evidence linking psychological factors with hypertension development. Mental disorders and hypertension: Factors associated with awareness and treatment of hypertension in the general population of Germany. Generalized anxiety and major depressive disorders, their comorbidity and hypertension in middle-aged men. Association between anxiety or depressive symptoms and arterial hypertension, and their impact on the quality of life. A descriptive and comparative study of the prevalence of depressive and anxiety disorders in low-income adults with type 2 diabetes and other chronic illnesses. A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetes. Prevalence of depression in individuals with impaired glucose metabolism or undiagnosed diabetes: A systematic review and meta-analysis of the European Depression in Diabetes (EDID) Research Consortium.
Help-seeking behaviour of patients attending the psychiatric service in a sample of United Arab Emirates population.
Help-seeking behaviour in men and women with common mental health problems: Cross-sectional study. Extra medical ways of help-seeking behaviour in patients with depression: Can alexithymia be a contributing factor? Patients who admitted to psychiatry clinic in a anatolian city explanation models for their illness and help-seeking behavior.
The prevalence of psychiatric disorders distribution of subjects gender and its relationship with psychiatric help-seeking. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.AbstractResearch into CAM use by people with diabetes is limited.

This quality PLR pack provides in depth and essential information about an important health topic. Her career has spanned 55 years, including time as a nursing instructor with the American Red Cross, a professor at Wichita State University, and an American Association of Diabetes Educators (AADE) board member.
By using the right terminology and understanding the psychosocial expectations of patients, I can see how everything intertwines with their management. We should move towards integrating the old with the new, and we need to have much more education on complementary and alternative medicine. It’s good to be cautious, but it’s also good to read and try to learn what can be useful for you as an individual. Even though most of the evidence is in people with type 2 diabetes, it could benefit people with type 1 diabetes, particularly those with bouncing blood sugars. Deep abdominal breathing not only helps lower blood pressure, but it also helps with test taking. Would those types of techniques fall into the deep breathing category of stress management? The term we use is “empowerment” – they can do these things on their own and monitor themselves with blood sugar testing.
It’s an herb that’s mainly been studied in India and actually has some blood sugar lowering effects for people with type 2 diabetes. We need more research on the therapies themselves – there are over 400 herbs that are known to lower blood sugar levels, but I think we have only tested maybe 10-15% of them. Well, maybe it’s not so puzzling, but from the standpoint of not doing any harm, it’s almost like they aren’t even willing to listen. Especially people that are taking yoga, or doing different activities that add to flexibility and circulation, or anything that relates to decreased stress on the body or improved healing – all of these will decrease overall blood sugar responses. To get education in early, I’ve spoken to younger children at a number of schools and also given out healthy snacks. We also need to help them feel more comfortable with their environment, food structures, and lifestyle.
One of my soapboxes is that since many endocrinologists have interests in problems other than diabetes – even though that’s probably their breadbasket type of work – I would like to see AADE have a certification line for physicians. But this would allow people to recognize that a certain family practice physician might not have any background in endocrinology other than what he studied in medical school.
They can also contact the Holistic Nurses Association or they can contact the Healing Touch Program and Healing Touch International.
This study is to determine the prevalence of mental disorders among patients diagnosed with DM and HT and their use of alternative medicine methods. This study explored CAM use among patients who attend diabetic clinics for followup treatment. After several years of research MannKind Corporation has invented the inhaler, a specific type of insulin that will be used in powder form.
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Her unparalleled credentials include certifications in holistic nursing and healing touch, a master’s degree in public health, and licenses as a professional counselor and marriage and family therapist. One of my major interests is in stress management, and there’s no question that adults who are highly stressed have a more difficult time in managing their diabetes. There are some things that are available to us that can be helpful for individuals and their families with diabetes.
We now have therapies that are available for increased flexibility and better diabetes management. There is actually research related to breathing effectively to increase short-term memory, especially if kids are cramming for a test. Once they get to the range where they need less medicine, they can decrease their medication through their own self-management or contact their health professional.
You could be responding to music or focusing on a machine with different colors and images that makes you feel calmer. I would also make sure that you were not putting down false information on your blood sugar test records. You could also do certain types of activities like Tai Chi or Chi Gong – if you are focusing on a sequence of positions, then your mind is off your problems.
Laura Shane-McWhorter, author of the American Diabetes Association Guide to Herbs and Nutritional Supplements, also recommends it.
Basically, information on complementary and alternative medicine is being used more frequently, and more physicians are willing to suggest it to their patients: “Well, why don’t you try going out and getting a massage?” or “Why don’t you try doing some kind of activity that decreases your heart rate?” When it comes to evidence-based diabetes care, there is no doubt that they need to have more information and more research to be sure it’s safe and effective.
I think people will have to develop their own comfort level or at least identify a person that is certified. We’ve gone in and done some relaxation practices and also handed out healthy snacks to children.
I think that’s one of the weaknesses in the healthcare armamentarium that AADE could handle very well.
I told my husband about that because he is an advisor for the Endocrinology Coding Conference. Also, Yale University, Wichita State University, and the Teacher’s College of New York have Internet courses for people working on their advanced preparation. Special attention was paid to patients' changing patterns of CAM use before and after diagnosis with Type 2 diabetes, their experience of CAM use, and their management of CAM use with conventional medicines. It’s exciting to see the better recognition of the erratic absorption of medication, the control of glucagon output, and how individuals handle food. I use feedback-enhanced relaxation training, and I remember an appointment with a 15-year old. The feedback mechanisms could be things like temperature, blood pressure, electromyography, etc.
When I am working with patients, I often say, “What are you doing for relaxation?” I’ll even ask a whole class to share what they do. We do see lower blood sugars and that certainly makes a lot of sense – having less adrenaline means you are not feeding yourself a lot of glucose from the liver to raise your blood sugar. Any time I talk to patients and they come up with something, or I suggest something, I say, “This is what you need to read. Eating nutritious food is one of the key things that is taught by holistic nurses as well as healing touch and therapeutic touch practitioners.
You might be a bit surprised at what was in those snacks, and what was considered healthier compared to what they’ve been eating.
A line for physicians could be handled the same way with all basic information, and then physicians could develop their own questionnaires. I also think more education and research is needed in complementary and alternative modalities, and the recognition that those modalities can be integrated in a very safe and effective way. It’s not an area we have focused on, but given your reputation and your wonderful Living Legend Award, we wanted to meet you – it’s been a privilege and you have given us a valuable new perspective. Along with the stress deriving from the chronic medical disease, sociodemographic factors play a role in the onset of mental disorders such as depression and anxiety disorder.
It’s a great honor just to be recognized by your peers – I thought that was the most wonderful thing. One might be very helpful for someone who craves sweets, but another might be harmful or unhelpful.
It’s also great learning more about the closed-loop system for those that are completely insulin dependent. And I’ll emphasize that there is no one thing that works for everyone – it’s what works for that individual. It may be especially useful in cutting down the costs that we have in healthcare practices to help people be healthier and live better lifestyles in a very, very safe way. You need to find out if this seems like it would be useful for you.” This is especially important in the first three to five days.
If we were not only paid for the patient but also for the health professional’s time, it would induce more clinics with team support. But she wanted to come in for a session, and I got her hooked up to the biofeedback machine.
When they have that sweaty response, it is usually the galvanic skin response, so we measure that. It might be exercise, or it might be a relaxation technique like focusing on how many minutes or how many miles.
They keep journals of any positive or negative responses that they get from using either a specific modality or herbal supplement.
Then you could deal with the psychosocial, medical, and nutritional management of these patients.
It involved patients aged between 18 and 65, who were on follow-up treatment for DM and HT.
Zimmet, “Global estimates of the prevalence of diabetes for 2010 and 2030,” Diabetes Research and Clinical Practice, vol. Sometimes, I use two or three different feedback mechanisms to be sure someone is relaxing.
Just calming or quieting thoughts or anything that gets the person away from stressful thoughts that can trigger an autoimmune reaction and bring those stress hormones into play. The leaves of the plant are chewed, “which can suppress the sweet taste sensation.” The article also mentions evidence that the herb may drop blood sugar by causing individuals with type 2 diabetes to secrete more insulin.

Additionally, there are things that you could put in your lifestyle that would keep you from stressing out and increasing blood sugar with illnesses and infections and challenges. Patients accepted to participate in the study were administered the sociodemographic data form, the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire and the alternative medicine inquiry form.
However, the authors conclude that there is not enough definitive evidence supporting use of gymnema sylvestre in people with diabetes. Participants: One hundred and sixteen patients with HT and 119 patients with DM (type 2) were recruited for the study. Although there are appropriate screening tests, less than half of the depression patients are diagnosed and receive treatment. Guthrie’s perspective on the great work being done by AADE and what it can do even better, what keeps her up at night, and what she finds most exciting about new therapies. I also have different tapes to help people relax – these might be self-discovery imagery or peaceful imagery.
Although her support for complementary and alternative medicine might be considered unorthodox or even controversial, we appreciated her fresh perspective and hope to hear more about these approaches at this year’s AADE annual meeting in August (we enjoyed a memorable panel discussion at AADE 2010 on how these therapies may be especially useful in people with long duration diabetes). View at Publisher · View at Google Scholar · View at PubMed · View at Scopus Department of Health in Taiwan, “Health National Health Insurance Annual Statistics: Life Statistics.
In this study, four HT patients (0.3%) and no DM patients stated that they resorted to complimentary medicine, which can use be used alongside conventional medical treatment and may help to feel better and cope better with any chronic condition. Some of the HT and DM patients suffering from a mental disorder seek psychiatric support, while others do not. Many hypertensive patients resort to alternative or complimentary medicine to control their blood pressure, and generally choose herbal methods. Loon, “Use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics,” Complementary Therapies in Clinical Practice, vol.
The participants of the study were selected based on the principle on voluntariness, from among the patients visiting the policlinics. The patient groups consisted of the patients whose diagnosis process was finalized.This is a cross-sectional study carried out with isolated type 2 DM (T2DM) and isolated HT patients that participated in the study on a voluntary basis between May and July 2012. Patients with an additional comorbid chronic disease to DM-HT comorbidity were excluded from the study.One hundred and sixteen patients diagnosed with HT and 119 patients diagnosed with T2DM participated in this study. Thirty-eight were excluded from the study because they either were suffering from an additional severe disorder or did not agree to participate.All patients that accepted to participate in the study were administered the sociodemographic data form, the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire and the alternative medicine inquiry form, after they signed the informed consent form. Following this process, the patients that might need psychiatric treatment and were diagnosed with a PRIME-MD were steered to the psychiatry clinic for reevaluation.Sociodemographic data form was designed by researchers in order to define sociodemographic characteristics of patients. Tiralongo, “Use of complementary and alternative medicine among people living with diabetes: literature review,” Journal of Advanced Nursing, vol. The form was completed by 235 patients taking part in the study.The primary care evaluation of mental disordersThe PRIME-MD is a questionnaire based on the interview model, designed to assist primary healthcare institutions in the accurate and quick diagnosis of common mental disorders such as mood disorders, anxiety disorders, somatoform disorders and alcohol abuse. On the general structure and characteristics of the variables before the inception of statistical analysis.
Kruskal-Wallis and Mann-Whitney were used, according to the group numbers, to analyze the data sets composed of independent measurements and not showing normal distribution. Descriptive statistics such as frequency and proportions, and inferential statistics were used. Houghton, “Prevalence of complementary medicine usage within a diabetes clinic,” Practical Diabetes International, vol. Only one patient among males and no patient among the females were diagnosed with possible alcohol abuse. If the length of disease is taken as a variable, the study revealed no correlation between the length of HT and DM and the PRIME-MD module diagnoses.The patients were also asked whether they demanded psychiatric support.
Answering this question, 70% of the patients demanded and 25% of the patients did not demand psychiatric support, and 5% mentioned that they were undecided. Arcury, “Complementary and alternative medicine use among adults with diabetes in the United States,” Alternative Therapies in Health and Medicine, vol. Our finding supports the results in both the chronic disease population and the general population that female individuals are more inclined to suffer from mental disorders.
The studies with HT patients focused more on the effects of medical disorders on the disease and the difficulty of controlling blood pressure in individuals diagnosed with a mental disorder, rather than on the prevalence of this disorder. The rate of mental disorders is also high among the HT patients visiting tertiary health care institutions.
Phillips, “Systematic review of herbs and dietary supplements for glycemic control in diabetes,” Diabetes Care, vol. In all types of diseases coexisting with anxiety and depression, the patients may resort to somatic symptoms or symptoms nonspecific to the given disease. The comorbidity of a physical disease with anxiety and depression causes an increase in all medical symptoms and makes it harder for patients to adapt to a treatment. Any mental disorder existing simultaneously with the disease may complicate the course and control of the disease. Various studies have drawn attention to the comorbidity of chronic physical diseases and mental disorders, and preferred solutions. Although it has been known that psychiatric problems have negative impacts on hospitalization periods and treatment processes of patients treated for a physical disease, the rate of demanding psychiatric consultation is still not sufficient.
The chronic physical diseases may cause mental disorders such as depression and anxiety in some patients. The comorbidity of mood, anxiety, and somatoform disorders with a chronic disease may delay the diagnosis of former disorders. It has been reported that the individuals that need psychiatric support do not always see a physician, but tend to seek social support and hide their mood by external control.
Willis, “The rise and rise of complementary and alternative medicine: a sociological perspective,” Medical Journal of Australia, vol. The patients suffering from a minor psychological disorder usually seek help from friends and relatives, and the females are more inclined to ask for help compared to men.
The feeling of inadequacy or aspiration to seek remedy, linked to a mental disorder, may lead patients to look for different methods and adopt nonmedical approaches due to the fear of being labeled. We did not find such type (like sorcery, religious methods) of alternative medicine usage in our patients.Our study revealed that the number of females who stated that they demanded psychiatric support was higher than that of men (12% vs. Men tend to disregard symptoms related to a disease, and believe that a disease is eliminated when they ignore it or to receive help when they suffer from a serious disease. A study has found a positive correlation between difficulty in expressing feelings verbally and going to physicians other than psychiatrists.
It has also been reported that women recognize their problems much better compared to men and resort to psychiatric support and health services more than men do. The high prevalence rate of mental disorders may result from the use of this questionnaire.
It is argued that the PRIME-MD questionnaire places the symptoms below threshold into the category of disorder, and thus presents high rates of mental disorders. Some of the HT and DM patients also suffering from a mental disorder seek psychiatric support, while some others do not. We believe it is important to examine patients for mental disorders, while they are being followed-up for a chronic disease and appropriate psychiatric treatment for patients with the comorbidity of a chronic disease and a mental disorder will contribute to the treatment of the chronic disease as well.Although there is a high patient satisfaction from the family medicine, [36] family physicians should be more alert about the prevalence of mental disorders as they are usually the first people to realize and diagnose various mental problems. It is obvious that the patients followed in policlinics due to a chronic disease require psychiatric support.
Therefore physicians should not ignore making a psychological evaluation of these patients already exposed to stress because of the chronic disease. It is important for early diagnosis and appropriate treatment that the patients are examined for their mental state at least during routine medical follow-up treatments.
Lee, “Patterns of using complementary and alternative medicine by stroke patients at two university hospitals in Korea,” Evidence-Based Complementary and Alternative Medicine, vol. Silverstein, “The prevalence and pattern of complementary and alternative medicine use in individuals with diabetes,” Diabetes Care, vol.
Ouyang, “Use of complementary and alternative medicine among adult patients for depression in Taiwan,” Journal of Affective Disorders, vol.
Kalton, Survey Methods in Social Investigation, Heinemann Educational Books, London, UK, 2nd edition, 1971. Moon, “Survey of the use of complementary and alternative medicine among Korean diabetes mellitus patients,” Pharmacoepidemiology and Drug Safety, vol. Gulec, “Complementary and alternative medicine use among Turkish diabetes patients,” Complementary Therapies in Medicine, vol. Egede, “National patterns and correlates of complementary and alternative medicine use in adults with diabetes,” Journal of Alternative and Complementary Medicine, vol. Mehrotra, “Knowledge, attitude and practice of complementary and alternative medicines for diabetes,” Public Health, vol. Bhatt, “Ayurveda and traditional Chinese medicine: a comparative overview,” Evidence-Based Complementary and Alternative Medicine, vol.
Chiou, Traditional Chinese Medicine in Dietary Therapy, Wun-ching Publishing, Taipei, Taiwan, 2005. Dunning, “Complementary therapies and diabetes,” Complementary Therapies in Nursing and Midwifery, vol. Brickman, “Complementary and alternative medicine use in children with type 1 diabetes: a pilot survey of parents,” Explore, vol.

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