For patients with diabetes, can being prayerful help them better deal with their condition?  Is prayer an effective tool in managing diabetes?

Prayer and Diabetes

A research conducted at Duke University’s Center for the Study of Religion/Spirituality and Health investigated how intrinsic religiosity affects a person’s medical outcome and general wellness.  Intrinsic religiosity i defined as one’s religious or spiritual beliefs rather than participation in organized religious activities.

The study found that people with higher levels of intrinsic religiosity better survived severe illnesses, experienced less depression in older age, less disability and mortality when faced with chronic disease, and had stronger immune system.

Another very small, unpublished study looked at the possibilities of enhancing self-management with the use of a prayer wheel.  Nine study participants with type 2 diabetes used the prayer wheel for a span of three months adding to their usual self-care diabetes management.  Glycosylated hemoglobin (HbA1c) values were measured before and after the three-month period and compared with the HbA1c values of a similar group of nine who were not involved in a prayer wheel study.

The study revealed that among nine participants, seven experienced a reduction in HbA1c levels during the study period.  The drop in HbA1c level averaged 0.9 percent.  The other two participants experienced an average increase of 0.4 percent in their HbA1c levels.

Meanwhile, five participants in the control group experienced an average drop of 0.5 percent in HbA1c and four experienced an average increase in HbA1c of 0.8 percent.  The study was done in October to January – months when common holidays such as Halloween and Christmas were celebrated and often result in an increase in HbA1c for many people.

The results of the unpublished study suggest that the use of prayer, when combined with other holistic approaches in diabetes management, have beneficial effects on one’s HbA1c level.

Benefits of Prayer

According to Dr. Regina Grace Ravara, a medical doctor and currently Dean of the College of Arts and Sciences at St. Paul University Manila, one benefit of being prayerful for diabetes patients is that it helps them accept their condition.  ”When you tend to be more prayerful, you tend to be more accepting.  And if you are an accepting person, your stress level is lower than those who are still in denial of their condition,” explains Dr. Ravara.

Accepting the fact that you are diabetic, lowers your stress level and reduces your cholesterol level as well, adds Dr. Ravara.  ”There is a decrease in the level of cholesterol because it can also be converted to sugar.  It adds to the level of sugar if you tend to be more stressed secondary to the stage of a disease condition,” says Dr. Ravara.

Pastor Richard mendoza, health director of the Central Luzon Conference of Seventh-day Adventists, says that prayer has indirect benefits to diabetics, and that it makes them hopeful and optimistic. “Prayer is a source of comfort and healing,” says Pr. Mendoza.  He adds that being prayerful helps diabetes patients become compliant with their medication and treatment.

Dr. Ravara believes that the act of praying is an act of sacrifice.  It is a way to completely entrust one’s self to God.  Dr. Ravara says that when we are sick, we become more faithful to God.  It is because sickness or disease may lead one closer to death, says Dr. Ravara.  As such, the act of praying and being spiritual can help a person cope with whatever disease condition.

According to Pr. Mendoza,the act of praying and being spiritual also helps promote healthy habits.  Most churches teach healthy lifestyle and temperance which includes exercise, good diet and nutrition.  These practices are fit and good for diabetics.

Spiritual and Emotional Healing

For people with diabetes, spiritual and emotional well-being is necessary for cure and survival, say Pr. Mendoza.  Diabetics who lack spiritual and emotional support are found to get worse, develop more complications and live miserably while suffering from their chronic disease.

Dr. Ravara agrees that spiritual and emotional healing is vital for diabetic patients.  ”It direct us on how we are going to cope with our problems,” explains Dr. Ravara.  She adds that it also gives diabetics a chance to accept things as they are.  Dr. Ravara emphasizes that significant people play a big role in a patient’s spiritual and emotional healing. “The way other people look at us would also contribute to our self-esteem,” explains Dr. Ravara.

Being prayerful and spiritual can definitely help diabetics accept their condition and better manage their disease.  However, it is still important to follow the advice of healthcare professionals on how to deal with diabetes and not rely solely on prayers.  Holistic management of any disease is still the key.

But when all else fails, leaving it all up to God has proven wonders for many.  As Pr. Mendoza says, “Let diabetics pray and be spiritually healthy.  They won’t regret the hope, the comfort, the willpower, the faith, and the joy brought about by putting their trust in the Lord.”

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Bohdjalian et al (2009) recruited 24 ODM for a multicenter open-label European feasibility trial. Each of them were treated with insulin and/ or oral hyperglycemic agents and had a body mass index between 33.3 to 49.7 kg/m2. These participants were implanted laparoscopica ly with a TANTALUS system.

The TANTALUS system provided gastric electrical stimulation which is synchronized to the refractory period of gastric electrical activity. It was applied during meals and was evaluated for safety and for improvement of body weight and glucose control in obese type two diabetics.

Researchers from the Medical University of Vienna noted 18 adverse events related to the implant procedure or the device reported in 12 subjects. Accordingly, all were short-lived and resolved with no sequelae.

It was also noted in the large majority of subjects the significant reduction of weight by 4.5 +/- 2.7 kg (p < 0.05) and HbA1c by 0.5 +/- 0.3% (p < 0.05). Moreover, a subgroup (n = 11) on stable or reduced oral medication, registered a weight reduction by 6.3 +/- 3.4 kg (p < 0.05) and HbA1c by 0.9 +/- 0.4% (p < 0.05). The group on insulin (n = 6) had no significant changes in weight and HbA1c.

In conclusion, such findings prove the effectivity of the TANTALUS system among obese type 2 diabetic subjects. “Gastric electrical stimulation can potentially improve glucose metabolism and induce weight loss in obese diabetic patients, who are not well-controlled on oral antidiabetic therapy,” the researchers explained. “Further evaluation is required to determine whether this effect is due to induced weight loss and/or to direct signal dependent mechanisms.”

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A study published in the journal of Periodontology found that diabetics with periodontal disease (inflamed gums around the teeth) who underwent the standard treatment for periodontitis had a simultaneous improvement in their blood glucose control.

Spanish and Portuguese researchers studied a small group of patients with type 2 diabetes with a diagnosis of moderate generalized chronic periodontitis and compared them with the same number of patients with the same condition but without diabetes. Both groups of patients underwent conventional periodontal root scaling and root planning and all showed significant improvement in gum bleeding, amount of plaque on teeth, and the degree of looseness of teeth after treatment.

Moreover, the researchers found that the group with diabetes had a significant improvement in glucose control, as indicated by a drop in their glycosylated hemoglobin levels (HbAlc) from 7.2 to 5.7. Study investigators say that there have been studies since the 1960s suggesting that periodontal disease worsens blood sugar control in diabetics and that diabetic patients have a higher risk of developing periodontal disease than non-diabetics.

Although further studies are still needed to confirm the association between proper gum care and diabetes control, researchers suggest that a two-way relationship exists between diabetes mellitus and periodontitis, with diabetics experiencing greater severity of periodontal disease and with periodontitis worsening blood sugar control in diabetics.

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What is HbA1C?
HbA1C test or the glycosylated hemoglobin A1C test reflects the average blood glucose control for the past two to three month period. It gives a good estimate of how well diabetes is managed over time. HbA1C measures the amount of glucose in the blood. It also shows the amount of glucose that sticks to the red blood cell, which is proportional to the amount of glucose in the blood.

According to Dr. Martin J. Abrahamson of the Joslin Diabetes Center, HbA1C is essential in measuring how effective one manages diabetes. It helps confirm self-testing results or blood test results by doctors. It also judges if the treatment plan works and reveals how healthy choices such as engaging in physical activities, maintaining a regular menu plan and taking medicines faithfully make a difference in diabetes control.

How is it done?
This test can be done on a sample of blood obtained from a fingertip or from a small vial of blood drawn from the arm and tested in a lab. For infants or young children, the area where the blood will be collected is cleansed with antiseptic and punctured with a sharp needle or a lancet. A bandage may be applied to the puncture site if there is any bleeding.
No special preparation is needed for, the test. You do not need to fast (stop eating) for it.

How often should it be done?
The HbA1C test for people with diabetes is necessary to measure how well the blood sugar is controlled over a period of time. In general, the higher the HbA1C value, the higher the susceptibility of developing diabetes complications. This holds true especially when HbA1C among diabetics increases on more than one occasion. HbA1C testing is usually recommended every three to six months. Non-diabetics generally have HbA1C values between four to six percent but normal ranges may vary with each laboratory. Expert organizations like the American Association of Clinical Endocrinologists and the International Diabetes Federation recommend HbA1C targets of less than 6.5 percent to prevent the complications of diabetes. However this target may not apply to all individuals, so consult your doctor about your HbA1C target and results.

What conditions may provide falsely high or low results?
Several conditions affect the HbA1C test results.Among the medical conditions that affect HbA1C results include anemia, sickle cell disease and chronic kidney disease.

Red blood cells (RBC) have a short life span. They only last up to 90 days.Those suffering from hemolytic anemia (premature destruction of red blood cells) are affected by falsely low HbA1C results because the RBC has less time to interact or bind with glucose molecules. High levels of vitamin C and E in the blood also decrease the HbA1C results.
Medical conditions such as iron-deficiency anemia and other forms of genetic abnormalities that occur in the hemoglobin may increase HbA1C results. Other factors that may provide high HbA1C results are alcoholism, taking large doses of aspirin, chronic use of opiate-containing drugs, having high levels of blood triglycerides, uremia* and high levels of bilirubin in the blood.

It is also important that the HbA1C be performed by a laboratory that uses a reliable assay. HbA1C testing in the Philippines unfortunately has not yet been standardized with many assays yielding inaccurate results. The International Federation of Clinical Chemistry and Laboratory Medicine is working on global standardization of HbA1C. Have your test done using an assay that has been certified.

Don’t be complacent about your condition. The HbA1C test won’t be enough to ensure control of diabetes. It is only one of the tests you need to do in order to manage the disease. Bear in mind to continually check your blood sugar at home or with your doctor. Aside from blood glucose monitoring, proper diet, regular exercise, medication and doctor visits will do wonders in bringing more than your blood sugar to normal level and manage diabetes.

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According to the UK journal, the new technique involves asking a person open-ended questions, listening to and repeating the interviewee’s answers, and ideally helping a person realize on his own what is holding him back from taking action to improve his health. A key feature of this approach is the avoidance of confrontation or arguments. Researchers randomly selected 66 diabetic teens to undergo the said therapy for a year. Teens who underwent the motivational interview had an average of four visits with a counselor, while those in the control group averaged six meetings. Out of the 66 participants, 60 completed the trial.

After a year, teens in the intervention group were found to have significantly lower levels of HbAlc (a measure of long-term blood sugar control) as compared to the other group. This difference remained after a researcher re-tested them a year later.Teens who underwent motivational interviewing also had higher levels of satisfaction in their lives, and were found to be less burdened with worry and anxiety. They also believed that with self-care they could combat the disease’s long-term complications and that the disease had lesser impact in their lives.

Researchers believe that this method of therapy would contribute much to helping teens battle their way through the disease. For them, finding the key elements in making the motivational interviewing work could also lead to changes in behavior in teens and result in a better outlook on how they deal with the disease.

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For Dr. Fernando, there are four aspects in the treatment of elderly diabetics: medication, proper diet, exercise and stress. According to him, it is very important that patients comply with their medication and that physicians should closely monitor medication adjustments for their patients. On proper diet, he acknowledges the important role that family members play in ensuring that diabetes patients get the right nutrition everyday. He also recommends seeking the help of a dietitian or a diabetes educator for proper meal planning. Dr. Fernando likewise swears on the power of exercise or regular physical activity in diabetes management.And lastly, he gives value to removing stress in our system as it could increase blood sugar levels.

Meanwhile, Dr. dela Vega believes that treatment goals for the elderly with diabetes should be less strict. “Based on the American Geriatrics Society guidelines,for persons age 65 and older, the HbA 1 C goal is less than or equal to seven percent if the older person is still of good functional practice.”This cefers to a patient who is relatively independent, has an active lifestyle, and is able to take care of himself. “But if the patient is already frail with multiple medical problems and has difficulty taking care of himself, then the HbA 1 C target is now less than or equal to eight percent, which is less stringent,” says Dr. delaVega. She explains that this is because intensive glycemic control may lead to malnutrition and hypoglycemia. Dr.Yu-Gan agrees that the elderly are more prone to develop hypoglycemia, and says that this is why they are more cautious with giving them medications. “The reason why they tend to develop more hypoglycemia is because sometimes their appetite is not that good as before so they might not eat after taking their medications,” she explains.

Lifestyle modifications like weight management through proper diet and exercise may be easier for adults with diabetes, but may already be quite difficult for the elderly. Restricting diet in the elderly may lead to hypoglycemia; while the decline in physical abilities may make exercise difficult for them. “In the elderly you might not expect them to be as active as the younger population. They might also have joint pains that would make it difficult for them to exercise or even to walk:’ Dr. Yu-Gan says.

Other conditions in the elderly like hypertension and other heart conditions also increase the challenge of treating diabetes in older persons.The presence of these co-existing conditions in the elderly also means taking various medications which increase the risk for adverse drug reactions. Sometimes, decreased physical and/or mental capabilities may also make it more difficult for an elderly to follow treatment regimens. Dr. Yu-Gan adds that frequent monitoring of elderly patients for complications is very important. “We should be aware that these complications might be present in these patients already.”

Part 3: Getting out of harm’s way

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The Philippines ranks 9th in Asia in terms of diabetes cases. Based on the latest National Nutritionn and Health Survey, the Philippines has a 4.6 percent diabetes prevalence rate. It is with this sense of urgency that pharmaceutical company GlaxoSmithKline (GSK) held the forum “Type 2 Diabetes: A Global Pandemic Media Workshop” last December 4, 2006 at the Makati Shangri-la Hotel. The smallgroup discussion gathered the country’s writers and editors from various health publications. Even workshop speaker Dr. Patricia Gatbonton is an editor for HealthNews magazine.

According to Dr. Gatbonton, the shift from traditional to Western diet is partly to blame for the ballooning cases of diabetes in Asia. “Diabetes is a lifestyle disease which calls for modification in lifestyle,” she said. However, most diabetics are either unaware of their condition or indifferent in properly managing their disease. Dr. Gatbonton cited data from Diabcare Study 2003 showing that 91 percent of Filipinos with type 2 diabetes have a mean HbAlc levell of 8.2 percent which translates to poor blood glucose control. For Filipinos, the ideal HbAlc or the average blood sugar for the last three months is 6.5 percent. “HbAlc cannot be faked. It is the gold standard measure and the most important tool in monitoring blood sugar,” Dr. Gatbonton said.

Furthermore, good blood glucose control is essential to prevent the development of diabetes-related complications. Dr. Gatbonton discussed drug therapy and the main kinds of treatments for people with type 2 diabetes: sulphonylureas, biguanides, thiazolidinediones, insulin, and glucosidase inhibitors. She said these drugs, however, don’t come without side effects. Along with exercise, proper diet remains to be one of the safest ways to complement healthy lifestyle with or without diabetes. As Dr. Gatbonton puts it, “Diabetic diet is not just for diabetics, it’s a healthy meal for everyone.”

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