The incidence of type 2 diabetes in the U.S. is rising steadily, with the U.S. Centers for Disease Control and Prevention estimating that two in five Americans will develop the disease in their lifetime. Two osteopathic family physicians share the strategies they use to help patients manage this difficult diagnosis.
‘A whole-body disease’
“Diabetes is a whole-body disease. It illustrates the osteopathic philosophy that the body is a unit—it’s very unusual to see a diabetes patient who doesn’t have any other diagnoses,” explains Randy Shuck, DO, the director of medical education at St. Petersburg (Florida) General Hospital. Indeed, type 2 diabetes has a long list of potential complications, including poor circulation, heart disease, gum disease, vision problems, mental health issues and infected sores on the feet.
Musculoskeletal ailments such as carpal tunnel syndrome, frozen shoulder and degenerative joint disease are also a risk for type 2 diabetes patients, notes Jay Shubrook, DO, a professor at the Touro University California, College of Osteopathic Medicine in Vallejo. Dr. Shubrook and Dr. Shuck have both used osteopathic manipulative treatment to treat diabetes patients with musculoskeletal complaints, though they say more research is needed in this area.
From hands-on diagnosis to disease management
DOs use lab results to diagnose type 2 diabetes, but they also use touch to discern subtle differences in skin texture that can indicate the disease, such as dark, thickened skin in the neck, armpits or groin, a condition known as acanthosis nigricans. “Often I’ll take the patient’s hand, put it on that spot and tell them what I’m feeling so they can feel it too,” explains Dr. Shuck.
Trained to treat body, mind and spirit, DOs understand the emotional toll of type 2 diabetes. “Unlike many illnesses, which either kill you or you recover from, diabetes is forever,” Dr. Shubrook says. Patients often suffer “diabetes burnout” from trying to sustain the daily grind of managing blood sugar and diet. To ease the burden, Dr. Shubrook recommends asking patients what’s most important to them and focusing on improvements to help with those areas, while continuing to suggest additional changes that would benefit their health.
Helping patients make lifestyle changes is a crucial component of treating type 2 diabetes. DOs can take a holistic approach to doing this by giving patients options and working with them to develop a plan. For example, if a patient has high blood sugar after meals, he or she could be offered the choice between adding a medication to stabilize post-meal blood sugar or taking a 20-minute walk after eating.
“Lifestyle changes are very impactful in diabetes, so it’s important to let patients know they have the power to choose,” Dr. Shubrook says.