Prevalence of complementary and alternative medicine (CAM) among diabetic patients in Eastern Mediterranean country members of the World Health Organization (WHO): A review

An evidence map on traditional medicine across health outcomes

Background

Traditional medicine (TM) plays a significant role in healthcare either as part of the primary healthcare system or as an adjunct to conventional medicine. This study aimed to map systematic reviews (SRs) of TM modalities across health conditions and identify gaps in the research literature to facilitate priority setting in future TM research.

Methods

We searched 17 databases from January 2018 to December 2022. Reviewers in pairs independently performed the database search, screened each record for inclusion, extracted data, and performed quality assessments using the AMSTAR 2 - A Measurement Tool to Assess systematic Reviews. To be included in this evidence map, the studies had to be SRs of clinical studies that evaluated the effectiveness of a TM modalities. The included SRs were analyzed according to TM modality, ICD-11 disease classification, and health outcomes, and visualized using graphical plots.

Results

We retrieved 241,509 records. After excluding duplicate records, 181,616 titles and abstracts were screened and 20,856 records were selected for full-text assessment, of which 18,137 records were further excluded. The final 2719 included SRs were primarily in adults (2591) with only 128 SRs in the pediatric population. The most commonly evaluated health conditions were diseases of the digestive system, circulatory system, and genitourinary system, with herbal medicine (n = 1867) and acupuncture (n = 471) being the most investigated TM modalities in treating these illnesses. Based on AMSTAR 2 criteria, the methodology quality of the included SRs is considerably low.

Conclusion

This evidence map provides a comprehensive overview of the extent and nature of the available research onTM modalities across health conditions. It provides an initial step towards characterizing the global evidence base and outlining gaps in the existing evidence. We regard this study as laying the basis for future research of TM modalities.

Registration

The protocol of this map is registered in PROSPERO (CRD42023416355).

Prevalence and predictors of traditional medicine use among persons with diabetes in Africa: a systematic review

The utilization of traditional medicine (TM) is prevalent among the general population in Africa; however, its use among individuals with diabetes in the region remains underdocumented. This review aimed to synthesize the available literature to identify the prevalence and predictors of TM use among persons with diabetes in Africa. A systematic search was conducted across multiple databases, including MEDLINE, Embase, CINAHL, and AMED, covering studies published from 2000 to April 2023. Of 1560 records identified, 24 articles met the inclusion criteria. The prevalence of TM use varied significantly, ranging from 12.4% to 77.1%, with a median prevalence of 50%. TM was commonly used concurrently with conventional medicine (CM) (35.4-88.4%), with a majority (63.8-91.3%) not disclosing TM use to healthcare providers. Female gender, long diabetes duration, use of oral antiglycaemic medication and family history of diabetes emerged as the most common factors that predicted the use of TM. This review highlights the widespread use of TM among individuals with diabetes in Africa, often in conjunction with CM. The high prevalence of undisclosed TM use emphasizes the urgent need for healthcare providers to actively inquire about TM use during clinical consultations to address potential herb-drug interactions and adverse effects.

Exploring Patient Beliefs and Medication Adherence in the Mediterranean Context: A Cross-Sectional Study in Patients with Cardiovascular Diseases and Cardiometabolic Disorders in Greece-The IACT-Study

BACKGROUND

Evidence has shown that poor adherence to vascular medications contributes to a considerable proportion of all cardiovascular disease (CVD) events and mortality. The aim of the present work was to examine patients' beliefs/views that affect their level of adherence to the assigned medical treatment in the context of a multi-center study in Greece.

METHODS

Between July 2022 and April 2023, 1988 patients (1180 females) with established cardiovascular disease or relevant cardiometabolic disorders were chosen from seven medical centers in Greece. The 4-item Morisky Medication Adherence Questionnaire gauged medication adherence and investigated patients' beliefs/views regarding treatment.

RESULTS

Among participants, 51.2% showed perfect medication adherence, contrasting with 48.8% displaying poor adherence. Patients with negative medication beliefs were around three times more likely to be non-adherent (OR = 2.73; 95% CI = 2.28-3.28). Non-adherers held concerns about drug efficacy (OR = 2.34; 95% CI = 1.10-4.97) and favored alternative therapies (OR = 2.25; 95% CI = 1.75-2.91).

CONCLUSION

The findings highlight the significance of addressing patient beliefs/views to improve medication adherence. The distinct Mediterranean context, influenced by cultural, socioeconomic, and clinical factors, emphasizes the need for tailored interventions. This underscores the call for contextually sensitive strategies to boost medication adherence and improve health outcomes in this unique region.

Swimming training and herbal nanoformulations as natural remedies to improve sensory-motor impairment in rat midbrain tumor models: system biology, behavioral test, and experimental validation

Motor impairment worsens health-related quality of life in patients with primary and metastatic midbrain tumors. Here, 56-male-Wistar rats were divided into eight groups: Normal group, Midbrain Tomur Model group, Model + Exe group, Model + Lipo, Model + Extract, Model + Lipo-Extract, Model + Extract-Exe, Model + Lipo-Extract + Exe. According to the aim, mid-brain tumor models were conducted by injections of the C6 glioma cell line (5 × 105 cell suspension) and stereotaxic techniques in the substantia nigra area. Furthermore, consumption of nanoformulation of herbals extract (100 mg/kg/day), crude extract (100 mg/kg/day), and swimming training (30 min, 3 days/week) as interventional protocols were performed for 6 weeks. In addition, we evaluated the effect of polyherbal nanoliposomes containing four plant extracts and swimming training on the GABArα1/TRKB/DRD2/DRD1a/TH network in the substantia nigra of the midbrain tumor rat model. Data emphasized that DRD2 might be a druggable protein with the network's highest significance cut-point effect that could modulate sensory-motor impairment. Furthermore, we found Quercetin, Ginsenosides, Curcumin, and Rutin, as bioactive compounds present in Ginseng, Matthiola incana, Turmeric, and Green-Tea extracts, could bind over the DRD2 protein with approved binding affinity scores. Based on our data, swimming training, and nanoliposome-enriched combined supplements could consider effective complementary medicine for motor impairment recovery induced by the midbrain tumor in the substantia nigra area. Hence, regular swimming training and natural medicines rich in polyphenolic bioactive components and antioxidative effects could modify and improve the dopamine receptors' function.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13205-023-03574-3.

Natural remedies medicine derived from flaxseed (secoisolariciresinol diglucoside, lignans, and α-linolenic acid) improve network targeting efficiency of diabetic heart conditions based on computational chemistry techniques and pharmacophore modeling

Cytokine storms lead to cardiovascular diseases (CVDs). Natural herbal compounds are considered the primary source of active agents with the potential to prevent or treat inflammatory-related pathologies such as CVD and diabetes. Flaxseed contains phytochemicals, including secoisolariciresinol diglucoside (SDG), α-linolenic acid (ALA), and lignans, termed "SAL." Hence, we evaluated the effect of the SAL on the H9c2 cardiac cells in hyperlipidemic and hyperglycemic conditions. Here, candidate hub genes, TNF-α, IL6, SIRT1, NRF1, NPPA, and FGF7, were selected as effective genes in diabetic cardiovascular pathogenesis based on in-silico analysis and chemoinformatic. Myocardial infarction (MI) was induced using H9c2 cardiac cells in hyperlipidemic and hyperglycemic conditions. Real-time qPCR was conducted to assess the expression level of hub genes. This study indicated that SAL compounds bound to the Il-6, SIRT1, and TNF-α active sites as druggable candidate proteins based on the chemoinformatics analysis. This study displayed that the TNF-α, IL6, SIRT1, NRF1, NPPA, and FGF7 network dysfunction in MI models were ameliorated by SAL consumption. Furthermore, SAL compounds improved the function and myogenesis of H9c2 cells in hyperlipidemic and hyperglycemic conditions. Our data suggested that phytochemicals obtained from flaxseed might have proposed potential complementary treatment or preventive strategies for MI. PRACTICAL APPLICATIONS: Phytochemicals obtained from flaxseed (SAL) could reverse diabetic heart dysfunction hallmarks and provide new potential treatment approaches in cardiovascular therapy. SAL could be considered complementary and alternative medicines for treating various disorders/diseases singly or synchronizing with prescription drugs.

Exercise Combined with a Chinese Medicine Herbal Tea for Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial

Objectives: Exercise and Traditional Chinese Medicine (TCM) herbal tea may improve glucose metabolism through quite different mechanisms while sharing some common effects. The purpose of this study was to discover whether the intervention of exercise combined with TCM herbal tea intervention could produce advanced improvement in glucose metabolism than exercise alone in community patients with type 2 diabetes mellitus (T2DM). Materials and Methods: This was a 12-week, randomized controlled trial in which 75 community patients with T2DM were randomly assigned to the single group (n = 39) receiving intervention of aerobic and resistance exercise three times per week and the combined group (n = 36) receiving intervention of TCM herbal tea (consisted of six substances) taken once daily besides the exercise. The change of glycated hemoglobin A1 (HbA1c), tested before and after intervention, served as the primary outcome. Other measurements include fasting plasma glucose (FPG), glycated serum protein (GSP), lipid profile, and physical fitness profile. Results: HbA1c and FPG levels and their changes showed no group difference. The level of GSP was lower, and its decrease was also larger after exercise combined with TCM herbal tea than after single exercise intervention (p < 0.05). Lipid profile and physical fitness parameters were similar in the two groups except the larger six-minute walk test (6MWT) power after the combined intervention (p < 0.05). Patients showed good compliance with the intervention and had similar exercise days or amount in the two groups. No patient reported serious adverse events or significant changes in other lifestyles. Conclusions: A 12-week of exercise combined with TCM herbal tea could not enhance the hypoglycemic effects by exercise alone in community patients with type 2 diabetes. However, the lower GSP level and larger 6MWT work brought by combined intervention suggest its potential benefits, and further studies are needed to explore the effects of longer period and larger dosage of intervention. Clinical Trial Registration Number: Chinese Clinical Trial Registry: ChiCTR1800018721.

The Prevalence and Pattern of Using Complementary and Alternative Medicine in Saudi Patients With Diabetes: A Cross-Sectional Study

Background Diabetes mellitus is a common disease in Saudi Arabia. Patients with chronic diseases, such as diabetes, tend to use complementary and alternative medicine (CAM) either as an addition or alternative to their medical therapy. Many studies have evaluated the CAM herbal products used by patients with diabetes; however, there have been few and inconsistent studies on other types of CAM, and most studies on CAM have focused on their use in type 2 diabetes. Objective This study aimed to determine the prevalence and patterns of CAM use among patients with type 1 or type 2 diabetes in Riyadh, Kingdom of Saudi Arabia. Methods This cross-sectional study was conducted in an adult Saudi population at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Data were collected from December 2019 to February 2020 using a data collection form and patient interviews. Results We included 332 patients, 43% of whom had type 1 diabetes; 26% of the patients had previously used one or more types of CAM. Approximately 53% of CAM users had glycated hemoglobin (HbA1c) level of ≥9%. Among CAM users, 51% mentioned that their blood sugar readings were improved with CAM treatments. Mind-body therapy was the most commonly used CAM (54%), followed by biologically based CAM, including herbs (46%). The most commonly used herbal supplements were black cumin (42%), followed by fenugreek (28%), myrrh (24%), frankincense (22%), cinnamon (15%), garlic (15%), and onion (15%). Older age and employment status were predictors of CAM use in Saudi patients with diabetes. The main sources of knowledge about CAM were from family and friends. Conclusions CAM use is common among Saudi Arabian patients with diabetes. Patients with diabetes who are aged >65 years and employment status were the main predictor of CAM use. Assessing CAM use is an important aspect of clinical encounters with Saudi patients, especially patients with type 1 diabetes.

Iranian nurses' knowledge and attitude toward complementary and alternative medicines: Is there any relation with quality of nursing care?

Background

Nurses play an important role in advising and guiding patients on effective treatments, and in this situation, it is better to be aware of complementary and alternative medicine (CAM) as well as the effects and side effects of different procedures. In addition, the quality of nursing care is directly related to the nurse's knowledge of the different treatments and preventions of different diseases and conditions. The present study aimed to investigate Iranian nurses' knowledge and attitude toward complementary and alternative medicines (CAMs) as well as their correlation with the quality of patient care.

Materials and methods

This cross-sectional study included 267 clinical nurses from three hospitals in southern Iran. The participants were recruited using convenience sampling methods in 2020-2021. A demographic questionnaire, knowledge and attitude toward CAM questionnaires, and the Quality Patient Care Scale were used to collect data.

Results

The mean score of CAM knowledge was 26.51, which was less than the questionnaire midpoint of 39. The mean score of attitudes toward CAM was 63.84, which was more than the questionnaire midpoint of 57. The mean score of the quality of patient care was 197.80, which was more than the questionnaire midpoint of 130. There was no significant correlation between knowledge about CAM, quality of patient care, and its dimensions. In addition, there was no significant correlation between attitudes toward CAM, quality of patient care, and its dimensions (P > 0.05).

Conclusion

The results of the present study showed that nurses' attitudes toward the use of CAM are positive and can be a sign of their readiness to use and further integrate clinically approved CAM in patient nursing care. Due to the role of nurses in patient care and treatment, there is a need to increase nurses' knowledge of CAM, and its training should be included in the nursing curriculum. More studies are needed to identify nurses' knowledge and attitudes toward CAM and its impact on the quality of nursing care.