I could hardly contain my anger and frustration while reading the comment by Joel Zonszein, MD, CDE, in “A differing opinion on the ACP’s New Diabetes Treatment Guidelines.” Dr Zonszein takes issue with the UK Prospective Diabetes Study recommendations for patients with type 2 diabetes and prediabetes to be taught therapeutic lifestyle modifications first. He also reports that the similar recommendations that were made by the American Diabetes Association and the NIH’s Diabetes Prevention Program are inadequate and miss the mark. Is he kidding? He is way too entrenched in our mainstream conventional medicine approach, which simply uses pharmaceuticals to help patients gain glycemic control. 

I have been in the field of diabetes for 30 years and am a Doctor of Nurse Practitioner and also a certified diabetes educator. I did my doctorate on using the Paleo diet (a low carbohydrate diet) to prevent the progression of prediabetes to type 2 diabetes. My results reveal that lifestyle modifications DO NOT fail. It is the patients who fail to carry them out. Every one of my study participants who followed my carefully laid out instructions for the study period had improved fructosamine, HDL cholesterol, triglycerides, weight, and BMI, and, of course, gained amazing glycemic control. Many went on to prevent type 2 diabetes.

It can be done and should absolutely not be discounted when dealing with our huge population of patients with prediabetes and type 2 diabetes. We just can’t give up!

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I certainly understand that there is a place in medicine for using pharmaceuticals. But nothing is more disheartening than to hear “when diet and exercise fail … use this drug.” You cannot solve a lifestyle disease with drugs. You can only solve it with lifestyle.

I teach RNs to become nurse practitioners in the graduate program of a local university, and I teach them all to never give up on people. The problem is not that we are not using the drugs right. It is that our society does not value living a healthy lifestyle … hence all the “lifestyle diseases” based on our modern culture such as type 2 diabetes, cardiovascular disease, and cancer. Until that changes, physicians such as Dr Zonszein will continue to attempt to treat lifestyle diseases exclusively with pharmaceuticals, and his patients will not get better.—Chrystyne Olivieri, DNP, FNP-BC, CDE

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