Evidence-based medicine strongly supports lifestyle changes for the prevention and treatment of type 2 diabetes, but are they accepted by patients, doctors, and health care providers or considered trivial compared with drug treatment?
The case reminds us of the biblical story of Naaman, the leper, landlord of the Syrian king. When he heard that Eli’sha, the prophet, might heal him, he moved from Syria to the door of Eli’sha with silver and gold to pay for his cure. He thought Eli’sha would do something extraordinary and impressive. Instead, Eli’sha simply sent a servant to tell him to wash in the Jordan. Naaman was furious and went back: such a long journey to Israel to hear that he merely had to wash! That would expose him to ridicule. Later, he reconsidered the advice, dipped himself in the Jordan, and his leprosy disappeared.
If we consider Naaman’s cure independently of God’s intervention, the story indicates that ordinary therapeutic measures, of apparently low value, may be more effective than complicated and expensive treatments. We propose to name after Naaman the scarce consideration given to diet and exercise in the prevention and cure of type 2 diabetes.
First, only a few patients are willing to comply with lifestyle changes as much as they would fulfill pharmacologic prescriptions. Behavioral changes are only apparently easy to achieve, but it was also not easy for Naaman to accept a treatment that might be useless. Structured programs based on education, cognitive approaches, and reinforcement methods are effective in promoting adherence to dietary recommendation and physical exercise (1), but most patients claim that they have no time to spend in these activities, not to mention extra time for exercise.
Second, physicians need specific training to lead patients into behavioral modifications. But are they really willing to adjust to this requirement? Academic curricula provide no room for communication abilities and group management, and physicians are fearful of losing their role when involved in educational programs, which are scarcely considered and poorly remunerated. Most doctors still believe that their duty is to offer prescriptive treatment to the increasing number of diabetic patients. There is no time left for cognitive approaches.
Finally, diabetes units need different facilities and staff, including psychologists and exercise physiologists, to carry out a comprehensive educational task. This results in objections from hospital boards, who are keener on funding technological developments. It is time for health care providers to redirect resources to behavioral strategies, which are extremely cost-effective in the long term, considering the cost of diabetes and its late complications.
In conclusion, Naaman syndrome is a widespread condition: patients, doctors, and health care providers need to eliminate it for an effective prevention and treatment of type 2 diabetes.
“Then went he down, and dipped himself seven times in Jordan … and he was clean” (2nd Kings 5:14).
