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Nat.J.Res.Com.Med .,2(1), 2013, 1 – 78. ORIGINAL RESEARCH ARTICLE
ISSN - Print: 2277 – 1522, Online: 2277 - 3517
Prevalence and Pattern of use of Complementary and Alternative Medicines by
the patients with Diabetes,attending a Tertiary care centre in Salem, Tamil Nadu.
S. Sangeetha Balamurugan, 2A .Swathi , 3C Kannan ABSTRACT
BACKGROUND: Diabetes is one of the most common c
hronic diseases affecting nearly 30% of Indian population. Diabetic individuals seek the use of complementary and alternative medicine due the chronicity of the disease and fear of side effects of allopathic drugs. Hence a study was done to know the Complementary & Alternative Medicines (CAM) used by the diabetic patients attending a tertiary care centre, in Salem, Tamil Nadu. OBJECTIVES: To
know the prevalence and pattern of use of Complementary & Alternative Medicines by the diabetic patients attending a tertiary care centre, in Salem, Tamil Nadu and To know how socio-demographic factors influences the use of Complementary & Alternative medicines in diabetic Patients. MATERIALS AND METHODS: It is a Cross-
sectional study, conducted during October 2011 to December 2011.A sample of diabetic patients (type 1 and type 2) attending Vinayaka Mission Hospital, outpatient department, in the diabetic clinic during this three months were study subjects, comprising of 134.They were interviewed using a pre-tested structured questionnaire to collect data on their history of diabetes, its duration, treatment history, use of Complementary & Alternative Medicines and socio- demographic history. RESULTS: It was observed that, the prevalence of diabetic patients using Complementary &
Alternative Medicines was found to be 70.1%. Most common indigenous medicines used are karela juice, methi, neem leaves, diabetic herb, homeopathic medicine, native powder. It was found that demographic variables such as age, duration of diabetes, and occupation had direct influence for the intake of CAM.CONCLUSION: A systematic
study of use of Complementary & Alternative Medicines a mong diabetic patients is necessary, as some of them can interfere in glycemic control along with proven toxicities for the patient.Hence the patient needs to understand the use of the correct medicines to keep their diabetes status under control. KEY WORDS: Diabetes, Complementary & alternative me
INTRODUCTION
Despite recent advances in care and management, Diabetes is one of the most common chronic diseases diabetes mellitus continues to be an important public affecting nearly 30% of Indian population. World health concern causing substantial morbidity and Health Organization states that there will be around mortality along with long term complications.(1) At 350 million diabetic individuals by the year 2030. (1) the same time, care of persons with diabetes has been influenced by a growing interest in complementary 1 Department of Community Medicine, Annapoorna Medical
and alternative medicines.(2,3) Complementary and
ollege, Salem, Tamil Nadu, 2Final year student and 3 Prof &
alternative medicine (CAM) refers to a wide range of Head Department of Community Medicine, VMKV Medical college, Salem, Tamil Nadu clinical therapies outside of conventional medicine. Corresponding author: Dr. S.Sangeetha Balamurugan,
(4) The term “complementary” refers to therapies that are used in conjunction with conventional Annapoorana Medical College, NH-47,Sankagiri main road, Periaseeragapadi, Salem- 636308, Tamil Nadu. E-mail: medicine, whereas “alternative” medicine includes balamurugan.sangeetha@rediffmail.com therapies that are used in place of conventional Nat.J.Res.Com.Med .,2(1), 2013, 1 – 78. medicine. CAM therapies are attractive to patients because it aids in self empowering, participatory approaches to care.(4) This practice among It was observed that, out of 134 diabetic patients who were interviewed, it was found that about 94 patients diabetics, may be due to the general fear about the (70.1%) of them were found to use Complementary side effects of antidiabetic drugs used in the modern system of medicine.Further they are reluctant to use insulin injections and they presume that CAM are Table 1—The baseline data of diabetic subjects
safe and offer cure . (5) Hence a study was done, to know the pattern of use of complementary and Demographic variable Values (n=134)
alternative medicine in diabetic patients attending a tertiary care centre, in Salem, Tamil Nadu. OBJECTIVES:
1. To know the prevalence and pattern of Complementary and alternative medicine
(CAM) therapy in diabetic patients
attending a tertiary care centre, in Salem, Tamil Nadu. 2. To know, how socio-demographic factors Table 1 describes the distribution of 134 diabetic patients,who were in the age group ranging from <30yrs to 70yrs,the mean age of the subjects were MATERIALS AND METHODS
41.1yrs±SD of 1.77yrs.The total number of males It is a Cross-sectional study, conducted during were 62(46.3%)and females were 72(53.7%).The October 2011 to December 2011.A sample of number of subjects having Type 1 diabetes mellitus diabetic patients (type 1 and type 2) attending were 3(2.2%) and those with type 2 diabetes mellitus V.M.K.V.M.C.H, outpatient department in the were 131(97.8%).The number of subjects using oral diabetic clinic during this three months were study subjects ,which comprised to 134. The patients were 269(19.4%) and both were 23(17.2%).The mean randomly selected and interviewed using a pre-tested duration of diabetes was 4.7±SD of 2.77yrs .(n=134) structured questionnaire to collect data on their type Table:2 Pattern of use of Complementary and
of diabetes, duration of diabetes, treatment history, alternative medicine(CAM) among diabetic patients
use of Complementary & alternative medicines, their pattern of use and socio-demographic history. They were enquired about the frequency of use of CAM, duration of use of CAM therapy , their source of motivation , belief about the medication and any change in glycaemic control. ANALYSIS:-
Statistical tests like Proportions and Chi-square test was used. Indigenous medicine 8 (19.1%) (Tablets/Powder) Data was tabulated on Microsoft excel sheets and *More than one type of CAM was used.
Nat.J.Res.Com.Med .,2(1), 2013, 1 – 78. Table 2 shows various complementary and Table 5: Changes noticed by the patients during or
alternative medicines that were popularly used by the after the use of CAM
94 diabetic patients such as Karela juice 57(60.6%) , Methi 40(42.6%) , Neem27(28.7%) , Homeopathic medicine 16 (17%) , Diabetic herb 12(12.8%) and Native powder or indigenous medicines 18(19.1%) .Most of the patients use more than one modality of treatment.(n=94). The frequency of intake of the CAM, by the Table 6: Socio-demographic profile of the Diabetic
diabetic patients was studied,and it was found that patients using CAM
majority , 37(39.4%) took them intermittently and about 36(38.3%) patients took them regularly and 21 (22.3%) took them once in a while.(n=94) Table (3). Table 3: Frequency of intake of Complementary and
alternative medicine by the diabetic patients
Age group
FREQUENCY NO OF PATIENTS (%)(n=94)
The persons responsible for motivating the diabetic patients to use CAM were fellow diabetics in 39(41.5%) patients, relatives in 38(40.4%) diabetes
patients, neighbours in 21(22.3%) patients, news papers and other media in 13 (13.8%)patients.(n=94) Duration of
diabetes
Table 4: Sources for motivation of the diabetic
patients to use CAM
MOTIVATING PERSONS NO OF
Education
CASES(%)(n=94)*
*More than one source of motivation were present Occupation
More than one source of motivation for the use of CAM was found among the diabetic subjects. medicines, the blood glucose level was monitored and recorded. After the intake of indigenous treatment
medicine 19 (20.2%) patients felt that their glycemic control was better, 30(31.9%) felt that there was no change and 45(47.9%) were not sure of any Nat.J.Res.Com.Med .,2(1), 2013, 1 – 78. Table 6,shows various socio-demographic factors drugs and insulin, in which 10( 43.5%) of them used influencing the intake of CAM among diabetic patients.As age increased, the use of CAM for diabetes also increased,which was found to be DISCUSSION
statistically significant. It was found that among Our study showed a high prevalence of use of diabetic patients below 30 yrs,none of them used CAM among diabetic individuals as 70%,which is CAM. Whereas among those in the age group of 30 similar to study conducted in new Delhi by Ankur to 40 years, 44 (62%) persons; between the ages of Sethi et al , in which 89 % of the diabetic patients 40 to 50 years 32(82%) ; between 50 to 60 years 10 who were attending tertiary centre in New Delhi ( 83.3%) and between 60 to 70 years 8(88.9%) were were found using indigenous medicines.(6) Our study is also similar to Gloria Y.Yeh et al,in which the It is found that among females 53 (73.6%) were prevalence of use of complementary and alternative using CAM as compared to males who were 41 medicine was 57% as seen in diabetic individuals. (7) While contrary to this, a study conducted by Leonard E.Egede et al ,found that among individuals with In relation to the type of diabetes, it was found diabetes ,only 8% of them used complementary and that all 94 diabetic patients using CAM belonged to type 2 Diabetes mellitus. (p<0.10)[Table 6] This study highlighted the pattern of use of The prevalence of use of CAM in relation to CAM,as majority of the diabetic patients used Karela duration of diabetes was found that among those ,who had diabetes of less than 5 yrs duration, , Neem27(28.7%) , Homeopathic medicine 16 (17%) majority of the subjects 67(85.9%) used CAM, and , Diabetic herb 12(12.8%) and Native powder or it showed a decrease in trend, with increase in indigenous medicines 18(19.1%) .Most of the duration of diabetes. (p<0.05)[Table 6] treatment.This is similar to study conducted by The prevalence of the use of CAM was more Leonard E.Egede et al,where Nutrition advice, life common among illiterate patients of 38(90.5)% and style diet, spiritual healing, herbal remedies (20% of it showed a decreasing trend with increase in level diabetic individuals) massage & meditation were used as a, modality of complementary and alternative medicine treatment . (8) . While,in a study conducted The prevalence of use of indigenous medicine by Gloria Y.Yeh et al, therapies like solitary prayer according to the occupation of the patients was or special practices (28%), herbal (7%) , commercial studied. This showed that 18 (40%)patients among diet (6%), folk medicine (3%) were used by diabetic those of the skilled workers, used CAM. Among individuals. (7) The study is similar to Ankur Sethi et semi skilled 24(77.4%) used CAM and among al,where majority of diabetic individuals used Karela unskilled like coolie,vendor etc 52(89.7%) used juice.The choice of the use of CAM reflects,the CAM. This shows us that as the occupation of people belief that,bitter the medicine,it will reduce the blood became more and more skilled the use of indigenous sugar level. (6) Many studies are conducted of CAM medicine decreased , and is found to be statistically use among persons with diabetes, in a wide range of CAM use, from use of herbs among 9% ,of low income Mexican American patients in Texas (9) , to among the diabetes patients using oral hypoglycemic use of traditional home remedies among 65% of drugs 69( 81.2%) as against those who had taken immigrant Vietnamese patients in California. (10) insulin was 15(57.7%) and combination of both oral Hunt et al , who surveyed Mexican Americans with type 2 diabetes and reported that although most of Nat.J.Res.Com.Med .,2(1), 2013, 1 – 78. the patients were aware of a variety of alternative It was found in our study, that females were more treatments for diabetes, many of them use beneficial commonly using CAM than males similar to Chi- Wai Lui et al, (14) although sex, race,type of diabetes, household income &co- morbidity were not The persons responsible for motivating the single predilection of CAM use in diabetic people, (8) diabetic patients to use CAM were fellow diabetics in 39(41.5%) patients, similar to study by Ibrahim A Oreagba et al,where 45.2% used herbal remedies The prevalence of use of CAM in relation to influenced by friends,relatives and colleagues. (11) duration of diabetes was found that majority of the This is also similar to Ankur Sethi et al in subjects 67(85.9%) had diabetes of less than 5 yrs which,diabetic individuals and relatives were the duration and it showed a decrease in trend, with main source of motivation to use CAM. (6) increase in duration of diabetes ,which is similar to study by Ankur Sethi et al,where maximum of patients with duration of illness less than 5 years medicines, the blood glucose level was monitored have incidence of 90% use of CAM. (6) This and recorded,majority 47.9% were not sure of any probably suggests that diabetic patients are change.Similar to study conducted in New Delhi in motivated by different sources to control the diabetes which,majority 31.8% were not sure of any changes in glucose control. (6) A Canadian study examining patients with type 1 &2 Diabetes who were enrolled The prevalence of the use of CAM was more in diabetic education program showed that one third common among illiterate patients of 90.6% and it of individuals who were taking alternative showed a decreasing trend with increase in level of medication they considered to be efficacious ( eg education.This is contrary to study by Leonard vitamin supplements , herbal remedies ). (12) Study E.Egede et al study,where higher educational status, done by Ryan et al , showed that a substandard were more likely to depend on Complementary & proportion of patients with diabetes who used herbal remedies and supplements (such as glucosamine for arthritis or Echinacea for respiratory infections ) but The prevalence of use of indigenous medicine a few of them who used herbal treatments (fenugreek according to the occupation of the patients was seeds or gymnema Sylvester commonly known as studied. This showed that 18 (40%)patients used gurmar ) have reported to be beneficial in individuals indigenous medicine among skilled workers, 24(77.4%)patients among semi skilled and 52(89.7%) among unskilled. This is similar to study Table 6,shows various socio-demographic factors by Ibrahim A Oreagba et al ,where the use of CAM influencing the intake of CAM among diabetic among unskilled workers was 74.8% and found to patients,our study showed ,as age increased, the use have significant difference.(11) Chi-Wai Lui et al in of CAM for diabetes also increased,probably due to his study found that, unemployed were more likely to fear of side effects due to aging, as well as the visit CAM practitioners. (14) This shows that, the disease chronicity. This study is similar to Leonard occupation of people has an effect on the use of E.Egede et al study,where old age (more than 60 years), were 2.4 times more likely to depend on Complementary & Alternative Medicines use. (8) CONCLUSION
Contrary to this, younger age diabetics were more Understanding patterns of use of complementary likely to visit CAM practitioners,as study conducted and alternative medicine among persons with by Chi-Wai Lui et al(14) and Jeongseon Kim et al. diabetes, will not only help the health professionals , by providing more informed clinical care but also Nat.J.Res.Com.Med .,2(1), 2013, 1 – 78. help policymakers grade relevant frame work for 7) Gloria Y. Yeh, David M. Eisenberg, Roger future policy and guide investigators in the further development of CAM research. Differentiating efficacy of use of indigenous medicine with that of allopathic medicine remains as a challenge till today. national survey. A M. J of public health Oct Studies providing such information’s would assist programme planners in the development of more accessible and effective services in preventing Zheng, Marc D. Silverstein. The prevalence ACKNOWLEDGEMENTS
alternative Medicine use in individuals with diabetes.Diabetes Care 2002;25(2): 324-329. The authors are grateful to , the Dean, and the Medical Superintendent of VMKV Medical College, prayer and insulin :Use of Medicinal and Salem, for their permission to conduct the study and alternative treatments by a group of Mexian colleagues of Community Medicine department for their support and the patients for their co-operation. 10) Mull DS, Nguyen N, Mull JD. Vietamese diabetic patients and their physicians : what REFERENCES
ethnography can teach us. West J Med. 2001; 175:307-311. 1) National Diabetes Fact Sheet: National 11) Ibrahim A Oreagba, Kazeem A Oshikoya, Diabetes in the U.S. Rev. ed. Atlante, Ga; among Urban residents in Lagos, Nigeria. Centers for Disease Control and Prevention ; ;Herbal therapies for diabetes. J Assoc Acad States.Am J Public Health. 2002 October; Association 60th Scientific Sessions, 2000. Nutrition, Lipids and Alternative Medicine. of alternative Medicine in diabetes mellitus. 4) Gurjeet.S ,Gloria Yeh. Complementary and Alternative Medicine Therapies for Diabetes : A Clinical Diabetes 2010;28(4) :147-155. &Joseph R. coll. Patterns & determinants of diabetes in Queensland, Austialia. Evidence- (alternative) medicine. J Clin Psychol 1994 15) Jeongseon kim, Mabel M.Chan. Factors 6) Anku sethi, Saurabh srivastava, S V Madhu. Prevalence and pattern of use of indigenous Source of Fund: None declared
tertiary care centre. J Indian Med Assoc Conflict of Interest: None

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