“Is there anything more I can do for my child on top of from insulin treatment?” This question is asked by many parents. There is an array of alternatives and extra treatment modalities – but how beneficial are they? What effects do they have, for example, on the HbA1c values? 

Hidden behind the expression ‘alternative medicine’, are some traditional methods that are very similar to those used in Western medicine. However, esoteric methods also belong to this group, whose followers are against anything based on scientific fact, and who cling to religiospiritual ideals. The term ‘alternative medicine’, therefore, is not one that can be clearly defined. The concepts and methods it uses, however, are understood to have one thing in common. They all veer away from the so-called Western medicine. 

‘Alternative’ as a supplement
Alternative medicine is sometimes also regarded as complementary medicine, i.e., medicine that can supplement Western medicine. On the other hand, the term ‘alternative medicine’ is, in many cases, a confusing one, as it implies a complete substitute to Western medicine, as the definition of the word ‘alternative’ is taken as meaning that one has a choice between two possibilities of equal worth. Meanwhile, the border between Western and alternative medicine is not clear: increasingly, there are many procedure being integrated into Western medicine (e.g., misteltoe therapy for tumours). However, not all methods in alternative medicine can be tested. This makes it difficult to include them in a discipline that bases itself almost entirely on the results of clinical studies and scientific experiments.

The search for alternative methods is a typical phenomenon, especially in those with chronic illnesses. There are even indications that chronically ill patients are the most frequent users of alternative healing methods. Parents of children with diabetes seldom doubt the necessity of insulin therapy, but they want to try all possibilities that exist for their child, and not to miss anything that might be of extra benefit. 

What helps in the case of diabetes?
Homeopathic and herbal remedies are most often used in children, even in acute cases. Recent data from the German Health Survey, a representative survey carried out on children and adolescents with diabetes and their parents, shows that around 4.6% use homeopathic medicine. This trend is triggering many studies on the effect of herbal medicines and other therapies on type 1 and, in particular, type 2 diabetes. 

Caution should be exercised as to the unknown side effects of untested plant extracts, and a heavy word of warning to those who decide to use these products, not as a complement to, but as a complete substitute to insulin therapy in type 1 diabetes. A critical case of diabetic ketoacidosis would result due to lack of insulin. 

In a comparable US study, the manner as to how exactly people with diabetes use alternative medicines was examined. The results showed that people with diabetes used alternative methods 1.6 times more frequently than in the rest of the population. It was shown that people of the older age group and with higher education tended to try out alternative methods more often. Unfortunately, this survey did not differentiate between those with type 1 and those with type 2 diabetes. 

Parents wanting to supplement insulin therapy
We surveyed 228 families of children or adolescents with diabetes from four cities (Berlin, Bonn, Leipzig, and Stuttgart) on their usage of alternative treatments. We found that between 11% and 28% of families used some kind of alternative treatment, especially soon after diagnosis. Around half of these were actually using these methods for the first time, especially in families heavily burdened by the diabetes. 

Content with Western medicine
This study also revealed that 98% of the families were content with Western medicine. The parents were asked to answer a four-point multiple choice questionnaire assessing the treating physician. Over 90% of those using alternative treatments clearly indicated their satisfaction. 

The vast majority (69%) declared that they had used one or only two alternative methods. The most important sources of information for the users were the treating physicians and family and friends. Happily, over 80% were thoroughly informed about the treatment – over the way it worked, how to use it, and the chances of success. In addition, 75% were informed as to the possible side effects and risks.

Of those who were able to give information on the costs of therapy, over half declared that they had spent less than 500 EUR for the alternative treatment, and the total range was found to lie between 100 and 5000 EUR. The most frequently used methods were homeopathy (14.5%), vitamins and minerals (13.7%), and dietary measures (12.9%). Aloe vera, cinnamon and bio-resonance was also high on the list. 

The quest for better values
The majority of those questioned used alternative methods just to try them out. Further to this, many were convinced that alternative methods would be more natural and have fewer side effects. 

The parents were also asked about their expectations. Most (92.1%) hoped that, through the alternative treatment, their child would feel better, blood sugar levels would fall (81.1%), and diabetes complications would be avoided (77.8%).

No measurable success
The parents were also asked to compare the benefits of the alternative treatment modalities to that of the conventional treatment. Nearly half replied that the alternative treatment was not as beneficial, 15% found it equally as effective, and only 1 individual found it to be better.

On the other hand, most (62.5%) rated the total success of the alternative treatment as positive (very good 12.5%, okay 50%, no effect 32.5%, bad 5%, very bad 0%). 

Of the measurable parameters, 66.7% denied any drop in blood sugar or HbA1c (72.2%) due to the alternative treatment. However, in 47.6% of the cases, the daily insulin dose was reduced, at least part of the time.

This study showed that the majority of patients (82%) did not use any alternative treatment. When asked as to why not, 90.3% indicated that they were content with the present treatment. Insulin therapy was considered by 74.3% to be the only effective means of treatment. 

In general, most people have little knowledge of alternative therapies. In our study, 78% admitted to having no knowledge of any alternatives at all. Perhaps they regarded alternative therapy as basically unsound, too expensive or useless. Many were not prepared to give a comment. Luckily, however, no family reported to have stopped the insulin therapy.

Feasibility studies on alternative medicine
Most studies aim to examine the effect herbal extracts, or supplements such as vitamins or trace elements, have on the blood sugar. Most studies are carried out on people with type 2 diabetes. Beneficial effects have been found with Coccinia indica, a herb commonly used in Ayurveda (a traditional Indian healing method), as well as with ginseng. Recently, cinammon has been reported to have a blood sugar reducing effect, albeit its use to this effect is not recommended.

What works for type 1 diabetes?
Complementary methods for the treatment of neuropathy in type 1 diabetes have been tested. However, this complication only appears after decades of bad metabolic control. Acupuncture, as a treatment for chronic, painful diabetic neuropathy, is considered to significantly relieve pain in over 75% of cases. Alpha-lipoic acid has become an well acknowledged mode of therapy for neuropathy. 

Animal experiments have revealed interesting results for the use of Aloe vera in type 1 diabetes. Aloe vera has been shown to have a blood sugar reducing effect. This effect, however, has not as yet been demonstrated in humans.
The effects of trace elements such as chromium, vanadium and magnesium have, as of yet, only been studied in people with type 2 diabetes.
The effect of relaxation techniques and stress management on metabolism and mood have also been studied on people with type 1 diabetes. It has been demonstrated that, although an improvement may occur in mood, they have no effect on fasting blood sugar.  

Biofeedback can help
Another study was able to demonstrate that, after 10 weeks of biofeedback and relaxation training, a significant improvement in mean blood glucose and fasting blood glucose. This effect was independent from any increase in insulin dosage. Biofeedback is a non-medical procedure that involves measuring the body’s regulation electronically and conveying this information to the patient in real-time. This raises the patient's awareness and, therefore, the possibility of conscious control of those functions. Biofeedback is good in combination with relaxation techniques.

Psychosocially oriented holistic treatment programmes can, particularly in ‘difficult’ cases, be of help. Many publications on this have appeared, especially in the area of traditional Chinese medicine. Unfortunately, a lot of these appear in the Chinese language. Consequently, it is possible that well organized studies have failed to penetrate the Western scientific literature.

Are alternative methods dangerous? 
Again and again we hear of cases in which, triggered by the stopping or reduction of insulin, patients using faith cures, spiritual methods, unusual diets, or the consumption of vitamins and trace elements, have fallen into acute ketoacidosis. Italian colleagues reported on two children whose parents reduced their insulin dosage due to the alternative treatments the children were on at the time. One child fell into a state of ketoacidosis and the other became severely metabolically unstable.

Serious side effects can also appear with natural products whose effects have not been tested by studies. The American Diabetes Association takes the position that only treatments approved by the Food and Drug Association can be recommended, with the exception of new treatment modalities currently being examined in clinical studies.

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Thomas M. Kapellen MD
Dept of Paediatric Diabetology and Endocrinology 
Children’s Clinic
Leipzig University
Germany
E-Mail: thomas.kapellen(at)medizin.uni-leipzig(dot)de