Prevalence and correlates of complementary and alternative medicine use among diabetic patients in Beirut, Lebanon: a cross-sectional study

BMC Complementary and Alternative Medicine

Yara Mourad¹  Leila Itani³  Hikma Shoaib²  Mohamad Alameddine¹  Dana Mousa²  Farah Naja² 

[1]Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon

[2]Faculty of Agriculture and Food Sciences, Department of Nutrition and Food Sciences, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon

[3]Faculty of Health Sciences, Department of Nutrition and Dietetics, Beirut Arab University, Riad El-Solh, Beirut 1107 2809, Lebanon

关键词: Lebanon;    Policy;    Integration;    Patient safety;    Prevalence;    Type-two diabetes mellitus;    Complementary and alternative medicine;   

Others  :  1220108
DOI  :  10.1186/1472-6882-14-185

 received in 2014-03-12, accepted in 2014-05-29,  发布年份 2014

【 摘 要 】

Background

Patients with Type 2 Diabetes Mellitus (T2DM) are increasingly using complementary and alternative medicine (CAM) therapies due to difficulty in adhering to the therapeutic regimens and lifestyle changes necessary for disease management. Little is known about the prevalence and mode of CAM use among patients with T2DM in Lebanon.

Objective

To assess the prevalence and modes of CAM use among patients with T2DM residing in Beirut, Lebanon.

Methods

A cross-sectional survey of T2DM patients was conducted on patients recruited from two major referral centers in Beirut- a public hospital and a private academic medical center. In a face-to-face interview, participants completed a questionnaire comprised of three sections: socio-demographic, diabetes characteristics and types and modes of CAM use. Descriptive statistics, univariate and multivariate logistic regression analyses were utilized to assess the prevalence and correlates of CAM use, as well as whether the use was complementary or alternative to mainstream medicine. The main outcome in this study, CAM use, was defined as using CAM at least once since diagnosis with T2DM.

Results

A total of 333 T2DM patients completed the survey (response rate: 94.6%). Prevalence of CAM use since diagnosis with the disease was 38%. After adjustment, CAM use was significantly associated with a “married” status, a longer duration of T2DM, the presence of disease complications, and a positive family history of the disease. Folk foods and herbs were the most commonly used CAM followed by natural health products. One in five patients used CAM as alternative to conventional treatment. Only 7% of CAM users disclosed the CAM use to their treating physician. Health care practitioners were the least cited (7%) as influencing the choice of CAM among users.

Conclusion

The use of CAM therapies among T2DM patients in Lebanon is prevalent. Decision makers and care providers must fully understand the potential risks and benefits of CAM therapies to appropriately advise their patients. Attention must be dedicated to educating T2DM patients on the importance of disclosing CAM use to their physicians especially patients with a family history of diabetes, and those who have had the disease for a long time.

【 授权许可】

   
2014 Naja et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]International Diabetes Federation (IDF): Diabetes Atlas. 6th edition. Brussels, Belgium: International Diabetes Federation; 2009.
• [2]Shaw JE, Sicree RA, Zimmet PZ: Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010, 87(1):4-14.
• [3]Al-Lawati JA, Al Riyami AM, Mohammed AJ, Jousilahti P: Increasing prevalence of diabetes mellitus in Oman. Diabet Med 2002, 19(11):954-957.
• [4]Wazaifi M, Afifi FU, El-Khateeb M, Ajlouni K: Complementary and alternative medicine use among Jordanian patients with diabetes. Complement Ther Clin Pract 2011, 17(2):71-75.
• [5]Jain S, Saraf S: Type 2 Diabetes Mellitus: its global prevalence and therapeutic strategies. Diabetes Metab Syndr: Clin Res Rev 2008, 4(1):48.
• [6]Sibai AM, Zard C, Adra N, Baydoun M, Hwalla N: Variations in nutritional status of elderly men and women according to place of residence. Gerontology 2003, 49(4):215-224.
• [7]Mehio Sibai A, Nasreddine L, Mokdad AH, Adra N, Tabet M, Hwalla N: Nutrition transition and cardiovascular disease risk factors in Middle East and North Africa countries: reviewing the evidence. Ann Nutr Metab 2010, 57(3–4):193-203.
• [8]Tohme RA, Jurjus AR, Estephan A: The prevalence of hypertension and its association with other cardiovascular disease risk factors in a representative sample of the Lebanese population. J Hum Hypertens 2005, 19(11):861-868.
• [9]Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, Maryniuk M, Peyrot M, Piette JD, Reader D, Siminerio LM, Weinger K, Weiss MA: National standards for diabetes self-management education. Diabetes Care 2012, 35(Suppl 1):S101-S108.
• [10]Chang HY, Wallis M, Tiralongo E: Use of complementary and alternative medecine among people living with diabetes: litterature review. J Adv Nurs 2007, 58(4):307.
• [11]World Health Organization: Adherence to Long-Term Therapies: Evidence for Action. 2003.
• [12]NIH: National Center for Complementary and Alternative Medicine. [http://nccam.nih.gov/health/whatiscam/ webcite]
• [13]Ernest E: Neue Deutsche Heilkunde’: complementary/alternative medicine in the Third Reich. Complement Ther Med 2001, 9(1):49.
• [14]Bishop FL, Prescott P, Chan YK, Saville J, von Elm E, Lewith GT: Prevalence of complementary medicine use in pediatric cancer: a systematic review. Pediatrics 2010, 125(4):768-776.
• [15]Sewitch MJ, Rajput Y: A literature review of complementary and alternative medicine use by colorectal cancer patients. Complement Ther Clin Pract 2010, 16(1):52.
• [16]Littlewood RA, Vanable PA: Complementary and alternative medicine use among HIV-positive people: research synthesis and implications for HIV care. AIDS Care 2008, 20(8):1002-1018.
• [17]Astin JA: Why patients use alternative medicine: results of a national study. JAMA 1998, 279(19):1548-1553.
• [18]Barnes PM, Powell-Griner E, McFann K, Nahin RL: Complementary and alternative medicine use among adults: United States, 2002. Adv Data 2004, 343:1-19.
• [19]Verhoef MJ, Balneaves LG, Boon HS, Vroegindewey A: Reasons for and characteristics associated with complementary and alternative medicine use among adult cancer patients: a systematic review. Integr Cancer Ther 2005, 4(4):274-286.
• [20]Ceylan S, Azal O, Taslipinar A, Turker T, Acikel CH, Gulec M: Complementary and alternative medicine use among Turkish diabetes patients. Complement Ther Med 2009, 17(2):78-83.
• [21]Giordano J, Boatwright D, Stapleton S, Huff L: Blending the boundaries: steps toward an integration of complementary and alternative medicine into mainstream practice. J Altern Complement Med 2002, 8(6):897-906.
• [22]Lee MS, Lee MS, Lim HJ, Moon SR: Survey of the use of complementary and alternative medicine among Korean diabetes mellitus patients. Pharmacoepidemiol Drug Saf 2004, 13(3):167.
• [23]Yeh GY, Eisenberg DM, Kaptchuk TJ, Phillips RS: Systematic review of herbs and dietary supplements for glycemic control in diabetes. Diabetes Care 2003, 26(4):1277-1294.
• [24]Bailey CJ, Day C: Traditional plant medicines as treatments for diabetes. Diabetes Care 1989, 12(8):553-564.
• [25]Ivorra MD, Paya M, Villar A: A review of natural products and plants as potential antidiabetic drugs. J Ethnopharmacol 1989, 27(3):243.
• [26]Marles RJ, Farnsworh NR: Antidiabetic plants and their active constituents. Phytomedicine 1995, 2:137.
• [27]Inanç N, Çiçek B, Şahin H: Use of herbs by the patients with diabetes in Kayseri, Turkey. Pakistan J Nutr 2007, 6:310.
• [28]Tan M, Uzun O, Akcay F: Trends in complementary and alternative medicine in eastern Turkey. J Altern Complement Med 2004, 10(5):861-865.
• [29]Yeh GY, Eisenberg DM, Davis RB, Phillips RS: Use of complementary and alternative medicine among persons with diabetes mellitus: results of a national survey. Am J Public Health 2002, 92(10):1648-1652.
• [30]Khalaf AJ, Whitford DL: The use of complementary and alternative medicine by patients with diabetes mellitus in Bahrain: a cross-sectional study. BMC Complement Altern Med 2010, 10:35. doi: 10.1186/1472-6882-10-35 BioMed Central Full Text
• [31]Cochran W: Sampling Techniques. 3rd edition. New York: John Wiley and Sons; 1997.
• [32]IBM: Statistical Package for the Social Sciences. SPSS Statistics 2013., 20
• [33]Leese G, Gill GV, Houghton GM: Prevalence of Complementary medicine usage within a diabetic clinic. Pract Diabetes Int 1997, 14(7):207-208.
• [34]Ryan E, Pick M, Marceau C: Use of Alternative Medicines in diabetes mellitus. Diabetes Med 2001, 18(3):242-245.
• [35]Argaez-Lopez N, Wacher NH, Kumate-Rodriguez J, Cruz M, Talavera J, Rivera-Arce E, Lozoya X, DIMSS Study Group: The use of complementary and alternative medicine therapies in type 2 diabetic patients in Mexico. Diabetes Care 2003, 26(8):2470-2471.
• [36]Chang HY, Wallis M, Tiralongo E: Use of Complementary and Alternative medicine among People with Type 2 Diabetes in Taiwan: A cross-Sectional Survey. Evid Base Complement Alternat Med 2011, 2011:1-8.
• [37]Kumar D, Bajaj S, Mehrota R: Knowledge, attitude and practice of complementary and alternative medicines for diabetes. Public Health 2006, 120:705.
• [38]Ching SM, Zakaria ZA, Paimin F, Jalalian M: Complementary alternative medicine use among patients with type 2 diabetes mellitus in the primary care setting: a cross-sectional study in Malaysia. BMC Complement Altern Med 2013, 13(1):148-155. BioMed Central Full Text
• [39]Ali-Shtayeh MS, Jamous RM, Jamous RM: Complementary and alternative medicine use amongst Palestinian diabetic patients. Complement Ther Clin Pract 2012, 18(1):16-21.
• [40]Salah SM, Jager AK: Screening of traditionally used Lebanese herbs for neurological activities. J Ethnopharmacol 2005, 97(1):145-149.
• [41]Assaf AM, Haddadin RN, Aldouri NA, Alabbassi R, Mashallah S, Mohammad M, Bustanji Y: Anti-cancer, anti-inflammatory and anti-microbial activities of plant extracts used against hematological tumors in traditional medicine of Jordan. J Ethnopharmacol 2013, 145(3):728-736.
• [42]El-Seedi HR, Burman R, Mansour A, Turki Z, Boulos L, Gullbo J, Goransson U: The traditional medical uses and cytotoxic activities of sixty-one Egyptian plants: discovery of an active cardiac glycoside from Urginea maritima. J Ethnopharmacol 2013, 145(3):746-757.
• [43]Tippens K, Marsman K, Zwickey H: Is prayer CAM? J Altern Complement Med 2009, 15(4):435-438.
• [44]Moreira-Almeida A, Koenig HG: Religiousness and spirituality in fibromyalgia and chronic pain patients. Curr Pain Headache Rep 2008, 12(5):327-332.
• [45]Ghazeeri GS, Awwad JT, Alameddine M, Younes ZM, Naja F: Prevalence and determinants of complementary and alternative medicine use among infertile patients in Lebanon: a cross sectional study. BMC Complement Altern Med 2012, 12:129. doi: 10.1186/1472-6882-12-129 BioMed Central Full Text
• [46]Robinson A, McGrail MR: Disclosure of CAM use to medical practitioners: a review of qualitative and quantitative studies. Complement Ther Med 2004, 12(2–3):90-98.
• [47]Stankiewicz M, Smith C, Alvino H, Norman R: The use of complementary medicine and therapies by patients attending a reproductive medicine unit in South Australia: a prospective survey. Aust N Z J Obstet Gynaecol 2007, 47(2):145-149.
• [48]Moolasarn S, Sripa S, Kuessirikiet V, Sutawee K, Huasary J, Chaisila C, Chechom N, Sankan S: Usage of and cost of complementary/alternative medicine in diabetic patients. J Med Assoc Thai 2005, 88(11):1630-1637.
• [49]Pagan JA, Puig A: Differences in access to health care services between insured and uninsured adults with diabetes in Mexico. Diabetes Care 2005, 28(2):425-426.
• [50]Riessman F: Alternative health movements. Soc Policy 1994, 24(3):53-57.
• [51]Alameddine M, Naja F, Abdel-Salam S, Maalouf S, Matta C: Stakeholders’ perspectives on the regulation and integration of complementary and alternative medicine products in Lebanon: a qualitative study. BMC Complement Altern Med 2011, 11:71. BioMed Central Full Text
• [52]Kemper KJ, Vohra S, Walls R: The use of complementary and alternative medicine in pediatrics. Pediatrics 2008, 122(6):1374.
• [53]Taylor O: Affordability of medicines for patients with diabetes attending University of Nigeria Teaching Hospital (UNTH), Enugu. PhD thesis. Republic of South Africa: University of the Western Cape; 2008.
• [54]Chin MH, Cook S, Jin L, Drum ML, Harrison JF, Koppert J, Thiel F, Harrand AG, Schaefer CT, Takashima HT, Chiu SC: Barriers to providing diabetes care in community health centers. Diabetes Care 2001, 24(2):268-274.
• [55]Mendis S, Fukino K, Cameron A, Laing R, Filipe AJ, Khatib O, Leowski J, Ewen M: The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries. Bull World Health Organ 2007, 85:279.
• [56]World Health Organization: Traditional Medicine Strategy 2002–2005. Geneva: World Health Organization; 2002.
• [57]Naja F, Alameddine M, Abboud M, Bustami D, Al Halaby R: Complementary and alternative medicine use among pediatric patients with leukemia: the case of Lebanon. Integr Cancer Ther 2011, 10(1):38-46.
• [58]Frenkel MA, Borkan JM: An approach for integrating complementary-alternative medicine into primary care. Fam Pract 2003, 20(3):324-332.
• [59]Frenkel M, Ben-Arye E, Hermoni D: An approach to educating family practice residents and family physicians about complementary and alternative medicine. Complement Ther Med 2004, 12(2–3):118-125.
• [60]Parker PA, Urbauer D, Fisch MJ, Fellman B, Hough H, Miller J, Lanzotti V, Whisnant M, Weiss M, Fellenz L, Bury M, Kokx P, Finn K, Daily M, Cohen L: A multisite, community oncology-based randomized trial of a brief educational intervention to increase communication regarding complementary and alternative medicine. Cancer 2013, 119(19):3514-3522.
• [61]Frenkel M, Ben Arye E: The growing need to teach about complementary and alternative medicine: questions and challenges. Acad Med 2001, 76(3):251-254.