INTEGRATED APPROACH FOR

DIABETES MELLITUS
BY
DR AHALYA P G
 INTRODUCTION
• Diabetes mellitus is a metabolic disorder characterized by common feature of
hyperglycemia with disturbance of carbohydrate , fat and protein metabolism.

• Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—

2019– ADA,

1. TYPE 1

2. TYPE 2

3. GESTATIONAL

4. SECONDARY
RISK FACTORS
SYMPTOMS
 PATHOPHYSIOLOGY
• INSULIN SECRETION:

Preproinsulin (86 aa)

proteolysis R. Endoplasmic reticulum
Proinsulin
further clevage
Insulin Golgi apparatus
(21aa) A chain B chain (30 aa)

C peptide
• TYPE I DM:

1. Genetic Factor - HLA DR 3& 4

2. Auto Immunity

3. Environmental Factors
 DIAGNOSIS
• HbA1C
• FBS
• PPBS
• RBS
• HOMA-IR index
• Urine Analysis
COMPLICATIONS
INTEGTARED APPROACH
CONVENTIONAL MEDICINE
RECENT ADVANCEMENTS
• INCRETINS
• SGLT 2 INHIBITORS

• AFREZZA

• TRANSPLANTATION

• STEM CELL THERAPY

• BCG VACCINE

• BARIATRIC SURGERY

• INSULIN PUMP
 HYDROTHERAPY
TITLE
Immediate hypoglycaemic effect
of two selective
Hydrotherapeutic procedures in
non insulin dependent Patients
of diabetes mellitus.
Effect of cold hip baths on blood
glucose levels in patients with
type 2 diabetes mellitus: a pilot
study
AUTHOR CONCLUSION
SUJATHA DINESH, Neutral douche and Gastrohepatic pack can play a
J Res Educ Indian Med, important role in lowering the raised blood glucose
2014 levels in patients with NIDDM.
A Mooventhan, • Doubling the metabolic rate
Diabetes and • TRPM8 activation is associated with ‘browning’
Metabolism , 2019 of white adipose tissue and acceleration of
energy utilization.
• CHBs are reported to promote parasympathetic
activation which, in turn, is known to promote
insulin secretion.
• exposure to cold (14–15℃) induces a 43%
increase in insulin sensitivity
 TITLE
The comparison of effects of
Contrast bath on circulation
of contralateral lower limb in
Type 2 Diabetic and healthy
women.
Whole body heat exposure
modulates acute glucose
metabolism.
Effect of Steam Sauna Bath on
Fasting Blood Glucose Level
in Healthy Adults.
AUTHOR
Zohreh,
Journal Of Rehabilitation
Science And Research, 2016
Amy L Kimbal,
Int Jour Hyperthermia, 2018
Vandana V, Prathap
Indian J Med Biochem, 2018
CONCLUSION
Contrast bath increases the digitalis pedis
pulse rate, local temperature by improving
the peripheral blood circulation in DM
patients and this effect is maintained for
longer duration when compared to control.
Whole body heat exposure increases the
insulin sensitivity and brings sympathetic
and parasympathetic balance.
When given three times a week there is a
significant reduction in the fasting blood
glucose levels.
 TITLE
1. Emphasis of Naturopathy in
the Management of Type 2
Diabetes Mellitus
2. Effect of Two Months
Naturopathy Treatment in
Non Insulin Dependent
Diabetes Mellitus Patients.
3. Role of Naturopathy on
physical and Biochemical
Parameters in patients with
Type 2 DM
AUTHOR CONCLUSION
Rukamani Nair et al., COLD HIP BATH:
JMSCR, 2016 It excites the contraction of muscular
structures of viscera including, liver,
pancreas, bladder.. and thus helps to
improve their function.
Rukamani Nair et al., MASSAGE:
JMSCR, 2017 The stress regulatory mechanism of
massage might be attributed to control of
stress hormone, permitting the body to use
insulin more effectively
MUD THERAPY:
Rukmani Nair et al., The mud application to abdomen increases
Indian journal of the peripheral circulation, metabolic rate
Traditional and helps to reduce blood glucose levels.
Knowledge, 2019
 MASSAGE
TITLE AUTHOR CONCLUSION

Tactile massage improves glycaemic Andersson, There is a significant B-HbA1c reduction,

control in women with type 2 diabetes: a Pract Diab Int, 2004 The possible mechanism might be the influence of tactile
pilot study massage on hypothalamo pituitary- adrenal axis, can
produce endocrine disturbances with consequent effects
on glucose metabolism.

How Effective is Swedish Massage on Firoozeh Sajedi, Full body massage, exercise and diet modification to
Blood Glucose Level in Children with Acta Medica Iranica, children with diabetes mellitus , has lowered the anxiety
Diabetes Mellitus? 2011 and stress hormones and improved clinical course

Effects of tactile massage on metabolic Wä ndell,r There is a significant reduction in the BMI, FBS, HbA1C,
biomarkers in patients with type 2 Diabetes and Metabolism HOMA IR, with increase in serum insulin, and adinopectin
diabetes , 2013 levels

Effects of Thai Foot Massage on Balance Uraiwan Chatchawan The results of this study suggest that Thai foot massage is
Performance in Diabetic Patients with Med Sci Monit Basic Res, a viable alternative treatment for balance performance,
Peripheral Neuropathy: A Randomized 2015 ROM of the foot, and the foot sensation in diabetic patients
Parallel-Controlled Trial with peripheral neuropathy.
 MAGNETOTHERAPY
TITLE
The effect of electric field, magnetic
field, and infrared ray combination
to reduce HOMA-IR index and GLUT
4 in diabetic model of Mus
musculus.
Transcranial Magnetotherapy in the
treatment of Psychosomatic
disorders in children with Type 1
Diabetes Mellitus
AUTHOR CONCLUSION
Warani D, Husen S A Combined treatment of electric field, magnetic
Lasers Medical Science , field, and infrared ray have potential to reduce
2019 insulin resistance due to improving blood
circulation and increasing intracellular Ca2+
level.
There is a significant reduction in fasting blood
glucose level and HOMA-IR index
Yu.Filina With magnetotherapy treatment for 12 mins
Neuroscience and there is a significant change in mood,
Behavioural Physiology , behaviour, activity of subcortical functions
2010 (memory, emotion, hormonal balances,
pleasure).
 ACUPUNCTURE
TITLE
Effect of Needling at CV-12
(Zhongwan) on Blood Glucose
Levels in Healthy Volunteers: A
Pilot Randomized Placebo
Controlled Trial
Clinical study on acupuncture
and moxibustion for Diabetes
AUTHOR
Sriloy Mohanty , A. Mooventhan
Journal of Acupuncture and
Meridian Studies, 2016
H Liao,
Chinese Acupuncture, 2007
CONCLUSION
The results of this present study showed
that a 20- minute single session needling at
CV-12 acupuncture point without any
stimulation (manual or electrical)
produced a mild reduction in RBG levels in
healthy volunteers.
Acupuncture, moxibustion or both when
given, the results are clinically significant
and better result is obtained when both
acupuncture and moxibustion is given.
 YOGA
TITLE
Adherence to yoga and its
resultant effects on blood
glucose in Type 2 diabetes: A
community-based follow-up
study
Effect of 12 weeks of yoga on
quality of life and Indian
Diabetes risk score in
Prediabetic and Diabetic Indian
Young Adults: RCT
Integrated Yoga and
Naturopathy module in
management of Metabolic
Syndrome: A case report
AUTHOR CONCLUSION
Praveen Angadi, Aarti
Jagannathan
International Journal
Of Yoga, 2017
Parvati Pal, G S Keerthi, 12 week yoga therapy improved the QoL
Journal of Clincal & among diabetics and attenuated the risk
Diagnostic Research, among prediabetes individuals.
2017
Swathi Gowda,
Journal of Ayurveda
and Integrative
Medicine, 2017
 DIET
TITLE
Effectiveness of Antihyperglycemic
Effect of Momordica charantia:
Implication of T-Cell Cytokines
Bitter melon (Momordica charantia):
A review of efficacy and safety
Effects of meal replacement therapy
on metabolic outcomes in Thai
patients with type 2 diabetes: A
randomized controlled trial
Do Cinnamon Supplements Have a
Role in Glycemic Control in Type 2
Diabetes – A Narrative Review?
AUTHOR CONCLUSION
Rufine Fachinan, TH2-immunosuppressive action of M. charantia
Evidence-Based fruit juice could be beneficial to prevent infiltration
Complementary and and destruction of 𝛽-cells by T-lymphocytes in
Alternative Medicine pancreas and therefore prevent hyperglycemia.
Ethan Basch, Decrease hepatic gluconeogenesis,
American Journal Of increase hepatic glycogen synthesis,
Health System And increase peripheral glucose oxidation in
Pharmacology, 2003 adipocytes.
Apussanee Short-term conventional low-Glycemic Index diet
Boonyavarakul, control showed decreased BW, BMI, HbA1c, total
Nutrition and Health, cholesterol and triglycerides and also great
2018 decrease in LDL levels
Rebecca B. Costello, Among 11 RCTs reviewed, 10 showed significant
J Acad Nutr Diet, 2007 change in FBS and HBA1C, and the doses varies
from 1.2 to 6gm/d.
• Targeting AMPK signaling pathway by natural products for treatment of diabetes mellitus and its
complications, Tanuj Joshi, Cellular Physiology , 2018
• Polyphenols and Glycemic Control , Yoona Kim, Jennifer B. Keogh and Peter M. Clifton, Nutrients, 2016
• Circulating levels of antioxidant Indoleproprionic acid are associated with higher gut
microbiome diversity, Menni C , 2019
• Gut microbiota – tryptophan metabolism – end product (IPA) – important regulator for
insulin resistance.
• Faecalibacterium and Coprococcus – Abdominal Obesity
• Lachnospiraceae – visceral fat deposition
• 6% change in flora – 1% change in metabolism
 AYURVEDA

• 30 ml of karela extract – empty stomach

• Vasantha kusumakra – 125mg/twice
• Chandra Prabhavathi – 250mg/thrice
• Dhanvantri ghritha + warm water – 48gm daily once
 HOMEOPATHY

1. Syzygium jambolanum
2. Uranium nitricum
3. Conium
4. Calendula

Homeopathic medicines in Type II Diabetic Individuals: A RCT, Moura L, 2019

 SIDDHA

• 15ml gooseberry juice + 15ml lemon juice + decoction of Senthil climber

• Fenugreek powder + hot water
• Fresh leaves of Aegle marmelos
• 6 fresh leaves of Andrographis daily
• Triphala powder twice daily
 UNANI

• Jamun seeds
• Karela
• Neem
• Binola seeds
• Bel leaves
• Falsa berry
 THANK YOU
MANITAIN YOUR HbA1C
BLOOD PRESSURE
CHOLESTEROL
TO HAVE A HEALTHY LIFE