Effect of Complementary and Alternative Medications (CAM) on Diabetic Control among Type 2 Diabetes Mellitus Patients

MATERIALS AND METHODS

Study location and population: This study was conducted in Zliten general hospital (ZGH) and Kadosh Diabetic Center (KDC) in Zliten city located in Misrata, Libya. Target population included the list of all Libyan patients who have DM in Zliten City. The study population included 192 adult diabetic patients from Endocrine ward of Zliten general hospital (ZGH) and Kadosh Diabetic Center (KDC). This number of participants was used in the descriptive part for all diabetes cases. Then 124 participants were included in the bivariate analysis to find the associated risk factors for those who are using the CAM only.

Study design and sampling methods: A cross sectional quantitative study was designed and carried out between the periods of August, 2017-October, 2017. Patients who fulfilled the inclusion criteria were identified and selected by the interviewer. Convenience sampling was used to collect the eligible respondents.

Instruments: The questionnaires developed by the researcher was based on the available factors taken from the literature review. The questionnaire was validated by using content and expert validity. Pilot study was conducted before data collection. The questionnaire included six sections. The first section included socio-demographic characteristics, duration of diabetic mellitus and types of medication. The second section assessed the perceived health condition and it consisted of one question with answers rating from 1-10 with higher score means better health. The participants would have very good health if they scored 8-10, good health if they scored 5-7 and not feeling good if they scored¹² <5.

The third section included question about CAM use, frequency of CAM use and types of CAM used. SAM use was defined as using any herbal products without medical prescription. The fourth section was based on attitudes towards CAM¹³. This was based on 10 statements related to attitude towards CAM usage. The statements were answered ‘yes’ or ‘no’ with a positive attitude equal to one and a negative attitude equal to zero. The total maximum score was 10. A higher score indicated a more positive attitude towards CAM usage.

A score of >6 was considered ‘good attitude’. The fifth section assessed the perceived improvement in sugar control due to CAM use. The question ranked from 0-10 in which higher score means higher control. A score of >6 was considered ‘improved’ and a score of <6 was considered ‘not improved’. The sixth section assessed the satisfaction with CAM use and the question was ranked from 0-10 in which higher score means higher satisfaction. A score of >6 was considered ‘satisfied’ and a score less than 6 was considered ‘not satisfied’

Statistical analysis: Face-to-face interview with patients based on a structured questionnaire format was opted in this study. All questions were constructed to ensure that each independent variable whether continuous or categorical was properly and thoroughly analyzed and independently accounted for.

Data was collected and analyzed by using IBM SPSS Statistics (Statistical Package for the Social Sciences) version 23. Descriptive statistics were used to describe all the included variables that have been used in this study. Mean±standard deviation described the numerical variables while frequency and percentage described the categorical variables. Independent sample t-test and chi square test were used in the bivariate analysis to identify the association between all included variables and our outcomes.

Ethical consideration: This study was approved by the Research committee in the medical faculty and Ethics Committee of Lincoln University College. Patients were informed about the purpose of this research. Verbal agreement and consent form were given by the patients before any sample collection or interview after ensuring the confidentiality to the participants. Participation was voluntary and the participants had the right to withdraw from the study at any time. Confidentiality was assured.

RESULTS

Descriptive analysis related to demographical factors, using type 2 treatments and using complementary medicine: The mean age±SD of the participants was 46.21±11.87 as shown in Table 1. Most of respondents were males (56.8%), married (71.4%) with tertiary education (37.6%) and their families’ income was in between 500-1000 D.L. Table 2 showed that the most of the participants were having diabetes for <40 years (53.1%), take tablet medication (60.9%), using CAM with medicine (64.6%) and about 49.5% good perceived their health.

Table 3 showed that out of 192 participants, 61.3% consumed CAM daily and the cinnamon was the most common CAM consumed (41.9%) followed by okra (13.7%), garlic and onion (7.3%), ginger (5.6%), green tea (4.8%) and other plants (28.6%).

Furthermore, 71.8% of the participants reported that their health condition was improved after using CAM along with their medication and 72.6% of them were satisfied by using CAM. The general attitude toward using CAM among the participants was good (52.4%). The frequency and percentage for attitude towards CAM are presented in Table 4. The highest percentage was presented for statements ‘CAM is better for your body than pharmacological drugs” (94%) while the lowest percentage was presented for the statement ‘It feels good psychologically to use CAM’ (40%).

Factors associated with control sugar by using CAM: Independent sample t-test and chi squared test was performed on 124 participants who consumed CAM while controlling sugar level including socio demographic and other factors related to the medication for diabetes. Factors associated significantly with perceived sugar control were type of pharmaceutical drugs used, perceived health condition, satisfaction with CAM, types of CAM used and frequency of CAM consumption (p<0.05). However, age, gender, marital status, educational status, income and age of having diabetes were not statistically significant with the sugar controlled by using CAM (p>0.05) (Table 5 and 6).

DISCUSSION

Diabetes mellitus is one of the most common and costly chronic conditions and reported that its global prevalence was approximately 366 million people by 2011 and expected to escalating to 552 million people^14-16 by the year 2030. From this study, it was identified the prevalence and some of the related factors that could influence in blood sugar control by consuming CAM.

As the incidence of diabetes in Libya was approximately 14.1%, which is one of the highest in the Arab world¹⁷. There are quite a number of people who consumed CAM together with their medications. Thus, we tried to highlight the factors related to diabetic patients with CAM consumption and their satisfactions towards the results. Investigations of the patients’ opinions and approaches towards CAM treatments are unusual. It is broadly viewed among the specialists that the utilization of CAM treatments is just connected to a specific social or ethnic background a cross-sectional study, a designed questionnaire form to evaluate the spontaneous CAM consumption therapies among 192 type-2 diabetic patients (average aged 46.21±11.87 years) in Zliten city in Misrata, Libya. Similarly, there was a previous study carried out in Libya, found that the mean age for diabetic was 48.37±11.62 years¹⁷.

This study also demonstrated that males were more prone to have diabetes compared to females and this data are keeping up with studies from different countries¹⁰. There are few common factors, found worldwide contributing to diabetes such as: people with low education background, low-income families and also high among the married couples. Our study demonstrated that most of the patients were having the diabetes when they aged <40 years-old. In contrary, previous researchers showed that the cut-off points of having diabetes was above 40 years-old¹⁷. The discrepancy of age could be due to different sample sizes and their modern life style especially in the rich countries and gulf countries.

It was also found that the Libyans prefer to use both types of medicines (injections and tablets) at the same time as they want fast outcomes which explained that the majority of them were in a good health condition with 49.5% compared to other groups^18,19. Moreover, it could be due to high percentage of using the CAM 64.6% together with medicines. Approximately 72.6% patients were able to control their blood sugar level and 71.8% of them are satisfied of the outcome. About 62.1% of them was shown not to have any symptoms after the CAM consumption and the association between CAM intake with health condition was statistically significant (p<0.001) and our results are in keeping with the previous studies²⁰.

Clinical trials studies on hypoglycaemic effects of cinnamon, bitter gourd, fenugreek and ivy gourd showed conflicting results. In this study, cinnamon, ginger, okra, garlic, onion, green tea and some others plants were included to see which of them are commonly used. Cinnamon (41.9%) was the reported to be most frequently used plant in this study followed by other plants (26.6%). It was demonstrated that there was a significant reduction in HbA1c with cinnamon intake which is supported by previous study²¹. It was showed the types of CAM is associated with sugar controlled (p<0.001). Although there are many studies on effects of cinnamon on blood sugar levels, its effects on HbA1c levels remains unknown⁹. This study is limited by a relatively small sample size and by the fact that study sample may be not representative for the Libyan population. Another limitation is the self-reported sugar control which is not based on laboratory investigation. We recommend future studies with bigger and representative sample to be conducted. To assess the effect of CAM on blood sugar a proper study design should be performed.

CONCLUSION

CAM is used commonly among most of the Libyan in Zliten city as more than 60% use CAM to control glucose level. Most of the participants were satisfied with CAM and had good attitude toward it. The most common CAM used was Cinnamon. Most of the participants were satisfied with CAM and had good attitude toward it. Factors associated with perceived sugar control were type of pharmaceutical drugs used, perceived health condition, satisfaction with CAM, types of CAM used and frequency of CAM consumption.

ACKNOWLEDGMENT

All appreciation goes to all individuals and organizations who contributed to the success of this research.

SIGNIFICANCE STATEMENT

This study discovered that 64.6% of our participants who used the complementary medicine, mostly cinnamon, are in a good health. It was shown that 72.6% of them were highly satisfied in using CAM with good attitude 52.4%. Around 94% of the participants demonstrated that CAM has better effects on general well being than pharmacological drugs. The type of pharmaceutical drugs used, perceived general health condition, satisfaction with the effects of different types of CAM and frequency of CAM consumption were the most important factors associated with controlling blood sugar level by CAM. This study will help the future researchers to reveal the importance of CAM usage for general health well being and explore more possible factors that may contribute in the lowering of blood sugar level.