Integrative Care for Type 2 Diabetes

Integrative Care for Type 2 Diabetes: Evaluating the Impact of Naturopathic Adjunctive Care for Diabetic Patients of a Family Health Team

A two year, two arm pragmatic trial to investigate the integration of naturopathic care with conventional medical care to provide additional benefit beyond that of conventional medical care alone in achieving adequate control of diabetes.

Inclusion Criteria:

• Males or females, enrolled as a patient with WE-FHT
• Ages 21-75 years old
• Diagnosed with type 2 diabetes and not adequately controlled (HbA1c > 7.0mmol/L)
• Currently seeking care with a medical doctor, nurse practitioner and/or physician assistant
• Willingness to adhere to randomized treatment with availability for follow-up
• Ability to answer self- and interviewer- administered questions in English or have an English speaking caregiver who can aid in answering self- and interviewer- administered questions
• Ability to provide written informed consent or give informed consent through substitute decision maker
• Capacity to maintain a diary and log of treatments and recommendations given during study

Exclusion Criteria:

• Lacking capacity for consent

• Pregnancy or an intention to become pregnant in the following two years

• Breastfeeding

• History of myocardial infarction within the past 6 months

• Chronic kidney (eGFR <30 mL/min) or liver disease

• Actively receiving care from a complex care diabetes clinic

• History of severe hypoglycemia in the last year resulting in hospital emergency care [where hypoglycemia is defined to be: 1) development of autonomic or neuroglycopenic symptoms, 2) low plasma glucose level (<4.0mmol/L for patients treated with insulin or an insulin secretagogue) and 3) symptoms responding to the administration of carbohydrate] or hypoglycemia unawareness

• Current bolus or pre-mixed insulin treatment

• Limited life expectancy (< 6 months)

• High level of functional dependency (inability to perform common activities of daily living)

• In participants aged 65yoa to 75yoa, the following also serve as exclusion criteria:

  1. Recent MI or stroke (within last 6 months)
  2. NYHA CHF Functional Capacity Stage III or above
  3. NYHA CHF Objective Assessment Stage C or greater (http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Classes-of-Heart-Failure\_UCM\_306328\_Article.jsp)
  4. Planned revascularization procedure (PCI or coronary artery bypass graft) or coronary angiogram within 90 days after screening or randomization