Complementary alternative medicine use among patients with type 2 diabetes mellitus in the primary care setting: a cross-sectional study in Malaysia

BMC Complementary and Alternative Medicine

Mehrdad Jalalian¹  Fuziah Paimin²  Zainul Amiruddin Zakaria⁴  Siew Mooi Ching³ 

[1] M.D., Mashhad, Iran;Family medicine specialist, Klinik Kesihatan Salak, Sepang, Malaysia;Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia;Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia

关键词: Prevalence;    Malaysia;    Primary care;    Diabetes mellitus;    Complementary alternative medicine;   

Others  :  1229432
DOI  :  10.1186/1472-6882-13-148

 received in 2013-01-23, accepted in 2013-06-20,  发布年份 2013

【 摘 要 】

Background

Limited study on the use of complementary alternative medicine (CAM) among patients with diabetes mellitus (DM), particularly in primary -care settings. This study seeks to understand the prevalence, types, expenditures, attitudes, beliefs, and perceptions of CAM use among patients with DM visiting outpatient primary care clinics.

Methods

This is a descriptive, cross-sectional study of 240 diabetic patients. CAM is defined as a group of diverse medical and healthcare systems, practices, and products that are not generally considered part of conventional Western medicine. Data analysis was done using SPSS v. 19 and multiple logistic regressions were used to identify predictors of CAM use.

Results

The prevalence of CAM use was 62.5 percent. Female were 1.8 times more likely than male in using CAM. Malays (75%) were the most frequent users, followed Indians (18%) and Chinese (6%). Biological therapy (50.0%) were the most widely used, followed by manipulative-body based systems (9.2%), energy system (8.8%), alternative medicine systems (4.6%) and mind-body system (1.7%). In biological therapy, a total of 30.4 percent, 24.2 percent, 13.3 percent, and 7.9 percent of diabetic patients consumed bitter gourd (Momordica Charantia), followed by Misai Kucing (Orthosiphon Stamineus Benth), garlic (Allium Sativum), and Sabah snake grass (Clinacanthus Nutans Lindau) respectively. The mean of the expenditure on CAM usage was RM 52.8 ± 101.9 (US $16.9 ± 32.5) per month. According to multiple logistic regression analyses, being Muslim (OR 5.258, 95 percent CI 2.952-9.368) had significant positive association with CAM use.

Conclusions

The prevalence of CAM use was high among diabetics. Islam faith is predictor for CAM use among Type 2 DM patients. The most-common herbs used were bitter gourd (Momordica Charantia) and Misai Kucing (Orthosiphon Stamineus, Benth). Further studies on the anti-glycemic activity of the isolated compound may be needed in the future.

【 授权许可】

   
2013 Ching et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]What Is Complementary and Alternative Medicine?. Accessed 8th January 2013 [http://cim.ucdavis.edu/clubs/camsig/whatiscam.pdf webcite]
• [2]Traditional Medicine Growing Needs and Potential - WHO Policy Perspectives on Medicines, No. 002, May 2002. Accessed 8th January 2013 [http://apps.who.int/medicinedocs/en/d/Js2293e/ webcite]
• [3]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.
• [4]Chang HY, Wallis M, Tiralongo E: Use of complementary and alternative medicine among people living with diabetes: literature review. J Adv Nurs 2007, 58:307-319.
• [5]Lee GBW, Charn TC, Chew ZH, Ng TP: Complementary and alternative medicine use in patients with chronic diseases in primary care is associated with perceived quality of care and cultural beliefs. Fam Pract 2004, 21:654-660.
• [6]Bausell RB, Lee WL, Berman BM: Demographic and health-related correlates to visits to complementary and alternative medical providers. Med Care 2001, 39:190-196.
• [7]Nahas R, Moher M: Complementary and alternative medicine for the treatment of type 2 diabetes. Can Fam Physician 2009, 55:591-596.
• [8]Modak M, Dixit P, Londhe J, Ghaskadbi S, Paul A, Devasagayam T: Indian herbs and herbal drugs used for the treatment of diabetes. J Clin Biochem Nutr 2007, 40:163-173.
• [9]Al-Saeedi M, Elzubier AG, Bahnassi AA, Al-Dawood KM: Patterns of belief and use of traditional remedies by diabetic patients in Mecca, Saudi Arabia. East Mediterr Health J 2003, 9:99-107.
• [10]Astin JA: Why patients use alternative medicine: results of a national study. JAMA 1998, 279:1548-1553.
• [11]Jamal P, Barkat AA, Amid A: Distribution of phenolics in various Malaysian medicinal plants. J Appl Sci 2010, 10:2658-2662.
• [12]Ibrahim J: The scientific values of Malaysian herbal products. Jurnal Sains Kesihatan Malaysia 2006, 4:59-70.
• [13]Grzywacz JG, Lang W, Suerken C, Quandt SA, Bell RA, Arcury TA: Age, race, and ethnicity in the use of complementary and alternative medicine for health self-management: evidence from the 2002 National Health Interview Survey. J Aging Health 2005, 17:547-572.
• [14]McMahan S, Lutz R: Alternative therapy use among the young-old (Ages 65 to 74): an evaluation of the MIDUS database. J Appl Gerontol 2004, 23:91-103.
• [15]Remli R, Chan SC: Use of complementary medicine amongst diabetic patients in a public primary care clinic in Ipoh. Med J Malaysia 2003, 58:688-693.
• [16]Hasan SS, Loon WC, Ahmadi K, Ahmed SI, Bukhari NI: Reasons, perceived efficacy and factors associated with complementary and alternative medicine use among Malaysian patients with diabetes mellitus. Br J Diabetes Vasc Dis 2011, 11:92-98.
• [17]Leese GP, Gill GV, Houghton GM: Prevalence of complementary medicine usage within a diabetes clinic. Practical Diabetes 1997, 14:207-208.
• [18]Clifford RM, Davis TM, Batty KT, Davis W: Prevalence and predictors of complementary medicine usage in diabetes: fremantle diabetes study. J Pharm Pract Res 2003, 33:260-264.
• [19]Ceylan S, Azal O, Taşlipinar A, Türker T, Açikel CH, Gulec M: Complementary and alternative medicine use among Turkish diabetes patients. Complement Ther Med 2009, 17:78-83.
• [20]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, 88:1630-1637.
• [21]Chang HA, Wallis M, Tiralongo E: Use of complementary and alternative medicine among people with type 2 diabetes in Taiwan: a cross-sectional survey. Evid Based Complement Alternat Med 2011, 2010:1-8.
• [22]Argáez-López N, Wacher NH, Kumate-Rodríguez 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, 26:2470-2471.
• [23]Lee MS, Lim HJ, Moon SR: Survey of the use of complementary and alternative medicine among Korean diabetes mellitus patients. Pharmacoepidemiol Drug Saf 2004, 13:167-171.
• [24]Kumar D, Bajaj S, Mehrotra R: Knowledge, attitude and practice of complementary and alternative medicines for diabetes. Public Health 2006, 120:705-711.
• [25]Bell RA, Suerken CK, Grzywacz JG, Lang W, Quandt SA, Arcury TA: Complementary and alternative medicine use among adults with diabetes in the United States. Altern Ther Health Med 2006, 12:16-22.
• [26]National Policy on Traditional/Complementary medicine. Accessed 8th August 2012 [http://www.mps.org.my/newsmaster.cfm?&menuid=37&action=view&retrieveid=1134 webcite]
• [27]Institute for Public Health (IPH): National Health and Morbidity Survey 2011 (NHMS 2011). Non-Communicable Diseases 2011, II:188.
• [28]Hasan SS, Ahmed SI, Bukhari NI, Loon WC: Use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics. Complement Ther Clin Pract 2009, 15:152-157.
• [29]Dunning T: Complementary therapies and diabetes. Complement Ther Nurs Midwifery 2003, 9:74-80.
• [30]Vincent C, Furnham A: Why do patients turn to complementary medicine? An empirical study. Br J Clin Psychol 1996, 35:37-48.
• [31]The World Health Report 2000-Health Systems: Improving Performance. Accessed 8th January 2013 [http://www.who.int/whr/2000/ webcite]
• [32]Muela SH, Mushi AK, Ribera JM: The paradox of the cost and affordability of traditional and government health services in Tanzania. Health Policy Plan 2000, 15:296-302.
• [33]Funnell MM, Anderson RM: Empowerment and self-management of diabetes. Clinical Diabetes 2004, 22:123-127.
• [34]Engel LW, Straus SE: Development of therapeutics: opportunities within complementary and alternative medicine. Nat Rev Drug Discov 2002, 1:229-236.
• [35]Dunning T, Chan SP, Hew FL, Pendek R, Mohd MA, Ward G: Transcultural therapy: a cautionary tale on the use of complementary therapies. Diabetes Primary Care 2001, 3:58-63.
• [36]Chatzimarkakis J: Why patients should be more empowered: a European perspective on lessons learned in the management of diabetes. J Diabetes Sci Technol 2010, 4:1570-1573.
• [37]Arcury TA, Bell RA, Snively BM, Smith SL, Skelly AH, Wetmore LK, Quandt SA: Complementary and alternative medicine use as health self-management: rural older adults with diabetes. J Gerontol B Psychol Sci Soc Sci 2006, 61:S62-S70.
• [38]Dannemann K, Hecker W, Haberland H, Herbst A, Galler A, Schäfer T, Brähler E, Kiess W, Kapellen TM: Use of complementary and alternative medicine in children with type 1 diabetes mellitus – prevalence, patterns of use, and costs. Pediatr Diabetes 2008, 9:228-235.
• [39]Kaptchuk TJ, Eisenberg DM: The persuasive appeal of alternative medicine. Ann Intern Med 1998, 129:1061-1065.
• [40]Population and Housing Census 2000-Department of Statistics. 2013. Assessed on 8th January 2013 [http://www.statistics.gov.my/portal/index.php?option=com_content&id=352&Itemid=111&lang=en webcite]
• [41]Yeh GY, Eisenberg DM, Kaptchuk TJ, Phillips RS: Systematic review of herbs and dietary supplements for glycemic control in diabetes. Diabetes Care 2003, 26:1277-1294.
• [42]Baldwa VS, Bhandari CM, Pangaria A, Goyal RK: Clinical trial in patients with diabetes mellitus of an insulin-like compound obtained from plant source. Ups J Med Sci 1977, 82:39-41.
• [43]Basch E, Gabardi S, Ulbricht C: Bitter melon (Momordica charantia): a review of efficacy and safety. Am J Health Syst Pharm 2003, 60:356-359.
• [44]Welihinda J, Karunanayake EH, Sheriff MHH, Jayasinghe KSA: Effect of Momordica charantia on the glucose tolerance in maturity onset diabetes. J Ethnopharmacol 1986, 17:277-282.
• [45]Mohamed EA, Mohamed AJ, Asmawi MZ, Sadikun A, Ebrika OS, Yam MF: Antihyperglycemic effect of Orthosiphon stamineus benth leaves extract and its bioassay-guided fractions. Molecules 2011, 16:3787-3801.
• [46]Misai Kucing-Mardi. Accessed 8th January 2013 [http://agromedia.mardi.gov.my/MEPIS/index.php/galeri-herba-2/88-misai-kucing webcite]
• [47]Ballali S, Lanciai F: Functional food and diabetes: a natural way in diabetes prevention? Int J Food Sci Nutr 2012, 63:51-61.
• [48]Ashraf R, Khan RA, Ashraf I: Garlic (Allium sativum) supplementation with standard antidiabetic agent provides better diabetic control in type 2 diabetes patients. Pak J Pharm Sci 2011, 24:565-570.
• [49]Sievenpiper JL, Arnason JT, Vidgen E, Leiter LA, Vuksan V: A systematic quantitative analysis of the literature of the high variability in ginseng (Panax spp.). Diabetes Care 2004, 27:839-840.
• [50]Blum A, Loerz C, Martin H-J, Staab-Weijnitz CA, Maser E: Momordica charantia extract, a herbal remedy for type 2 diabetes, contains a specific 11β-hydroxysteroid dehydrogenase type 1 inhibitor. J Steroid Biochem Mol Biol 2012, 128:51-55.
• [51]Dans AML, Villarruz MVC, Jimeno CA, Javelosa MAU, Chua J, Bautista R, Velez GG: The effect of Momordica charantia capsule preparation on glycemic control in type 2 diabetes mellitus needs further studies. J Clin Epidemiol 2007, 60:554-559.
• [52]Ooi CP, Yassin Z, Hamid TA: Momordica charantia for type 2 diabetes mellitus. Cochrane Database Syst Rev 2012., 8CD007845
• [53]Sakdarat S, Shuyprom A, Ayudhya TDN, Waterman PG, Karagianis G: Chemical composition investigation of the Clinacanthus nutans Lindau leaves. Thai J Phytopharm 2006, 13(2):13-24.
• [54]Hutch RA: Health and Healing: Spiritual, Pharmaceutical and Mechanical Medicine. J Relig Health 2011, 27:1-11.
• [55]Micozzi MS: Fundamentals of Complementary and Integrative Medicine. 3rd edition. Saunders: Elsevier; 2005.
• [56]Lim MK, Sadarangani P, Chan HL, Heng JY: Complementary and alternative medicine use in multiracial Singapore. Complement Ther Med 2005, 13:16-24.
• [57]Aziz Z, Tey NP: Herbal medicines: prevalence and predictors of use among Malaysian adults. Complement Ther Med 2009, 17:44-50.
• [58]Egede LE, Ye X, Zheng D, Silverstein MD: The prevalence and pattern of complementary and alternative medicine use in individuals with diabetes. Diabetes Care 2002, 25:324-329.
• [59]Merican I: Traditional/complementary medicine: the way ahead. Med J Malaysia 2002, 57:261-265.