Knowledge, attitude and practice of patients with type 2 diabetes mellitus towards complementary and alternative medicine

Use of Complementary and Alternative Medicine Among Patients With Diabetes Mellitus: A Cross-Sectional Study

Background Diabetes mellitus is one of the causes to use complementary and alternative medicine (CAM), which can be classified into nutritional, psychological and physical. The study's objective was to estimate the prevalence and pattern of using CAM among patients with diabetes mellitus who followed the endocrine and diabetes center in Taif. Materials and methods A cross-sectional study was carried out in Taif city from 1 June to 31 July 2023 among diabetic patients aged 14 years and above who followed the endocrine and diabetes center. A valid, reliable, English questionnaire was used in data collection. It was composed of three parts: demographic data, diabetes mellitus history and use of CAM. Patients visited the diabetic center during the study period for their regular appointments were selected randomly and interviewed by trained interns and medical students. By using the Raosoft calculator, the minimal sample size was 361. The chi-square test and independent two-sample t-test were used to investigate the association between categorical variables and continuous numerical variables, respectively. Multivariate logistic regression analysis was performed to control the confounding effect. Results A total of 361 patients were included. Their age ranged between 14 and 84 (51.2 ± 16.9 years). Females represented 57.6% of them. Overall, more than a quarter (28.3%) reported using CAM, while 22.4% used CAM for treating diabetes in the last 12 months. The majority of patients (97.1%) used herbs, mainly cinnamon (48.5%), fenugreek/helba (31.3%) and rosemary (20.2%). Their main source of information was family and friends (64.7%). A history of improvement of blood sugar reading with CAM was reported by 61.8%. Multivariate logistic regression analysis revealed that females were at doubled likelihood to use CAM compared to males (Adjusted odds ratio "AOR" = 2.40; 95% confidence interval "CI": 1.27-4.52, p=0.007). Compared to never-smokers, ex-smokers were more likely to use CAM (AOR=2.87; 95% CI: 1.28-6.43, p=0.010). Conclusion The use of CAM, particularly herbs, to treat diabetes is a relatively common practice among Saudi patients. However, the history of informing treating physicians about CAM was reported by a minority of patients.

The acceptance of traditional Chinese medicine among patients with Parkinson's disease: A hospital survey

OBJECTIVE

The efficacy of medications for Parkinson's disease (PD) tend to decline over time, which has a serious impact on patients' health and quality of life. To some extent, traditional Chinese medicine (TCM) can resolve the distressing problem of ineffective dopaminergic medication in PD patients. The purpose of this study was to investigate the attitude, acceptance, and independent predictors of TCM in PD patients admitted to the outpatient department of a tertiary hospital.

METHODS

A cross-sectional study of PD patients was conducted in the outpatient department of a large tertiary hospital in Beijing from March 2022 to June 2023. A self-report questionnaire was developed to investigate PD patients' attitudes and acceptance of TCM based on the questionnaire. Multivariate logistic regression analyses were also performed to further clarify the independent predictors influencing patients' adoption of TCM therapy.

RESULTS

A total of 397 patients completed the questionnaire, of which 78.09% were willing to be treated with TCM and 21.91% indicated that they were not willing to use TCM. Multifactorial logistic regression analysis showed that several parameters were correlated with a patient's willingness to include TCM in their therapeutic regime. These included education level of a bachelor's degree (odds ratio [OR) = 8.554; 95% confidence interval [CI]: 4.112-17.794; P < 0.001, vs junior high school education), living in an urban setting (OR = 8.022; 95% CI: 4.577-14.060; P < 0.001, vs rural), having other underlying diseases (OR = 5.126; 95% CI: 3.078-8.537; P < 0.001, vs none), having previously used TCM (OR = 3.083; 95% CI: 1.852-5.134; P < 0.001, vs not used), believing that TCM therapy is safe (OR = 3.530; 95% CI: 1.446-8.616; P = 0.006, vs not thought), believing that TCM therapy is effective (OR = 3.859; 95% CI: 1.482-10.047; P = 0.006, vs not understood), and being willing to discuss ongoing TCM therapy with an attending physician (OR = 62.468; 95% CI: 30.350-128.574; P < 0.001, vs not informed).

CONCLUSION

This study initially investigated the acceptance, attitude, and independent predictors of TCM use among PD patients. To expand the prevalence of TCM use among patients with PD, we recommend to broadening the public outreach for TCM via contemporary means of Internet and broadcast communication, enhancing access to TCM services in rural communities, and strengthening the communication between doctors and patients. Please cite this article as: Wang P, Hong J, Tang ZQ, Gong BZ, Qi XR, Jiang H, Pan B, Chen Q. The acceptance of traditional Chinese medicine among patients with Parkinson's disease: A hospital survey. J Integr Med. 2024; 22(2): 180-187.

The Prevalent Use of Complementary and Alternative Medicine Among Patients With Chronic Disease in the Al-Madinah Population of Saudi Arabia

BACKGROUND

Global interest in complementary and alternative medicine (CAM) has recently risen, particularly in Saudi Arabia, and the use of CAM is gaining popularity as a healthcare option.

OBJECTIVES

This study aims to assess the prevalence of CAM use among patients with chronic diseases and identify the reasons for resorting to CAM in Al-Madinah, Saudi Arabia.

METHODS

A cross-sectional study was conducted in Al-Madinah City. Data for analysis were derived from 416 participants with chronic diseases. The data were collected using a valid, structured online questionnaire that was designed to extract socio-demographic data as well as data on the predominant use of herps, hijama (cupping), acupuncture, and other specific CAM applications. The collected data were analyzed using appropriate statistical methods.

RESULTS

Of the 416 participants, 164 (39.4%) were men, and 96.9% were Saudi citizens. Approximately one-third of the studied participants had diabetes (34.1%), while 29.3%, 25.2%, 15.1%, and 12.3% had hypertension, obesity, asthma, and gastrointestinal tract disease, respectively. The prevalence of herb and natural supplement use was 89.2%. The most commonly used herbs and natural supplements were ginger (55.5%), honey and its derivatives (53.4%), cinnamon (45.4%), and frankincense (33.4%). Of the studied participants, 36.1% and 6.5% reported undergoing cupping and acupuncture, respectively. No statistically significant differences were found between the use of herbs and acupuncture or any of the studied factors. Further, the use of acupuncture exhibited no significant differences. However, the use of cupping displayed statistically significant differences in age, sex, and income among the participants.

CONCLUSION

The prevalence of CAM use among patients with chronic diseases in Al-Madinah is high. It appears to play an essential role in health care, particularly in treating patients with chronic diseases in this population. Therefore, promoting research in the field of CAM is warranted.

Complementary and Alternative Medicine Use Among Patients With Diabetes Mellitus in Saudi Arabia: A Community-Based Cross-Sectional Study

BACKGROUND

Global studies have observed a disparity in the use of complementary and alternative medicine (CAM) among diabetic patients.

OBJECTIVES

To estimate the prevalence, types, and correlates of CAM use among patients with diabetes mellitus (DM) in Saudi Arabia.

METHODOLOGY

A cross-sectional study was conducted among 1290 Saudis with type 2 DM aged ≥18 years. An electronic questionnaire was distributed through social media to collect data about patient demographics and DM-related characteristics, including age at DM diagnosis, DM duration, family history of DM, DM complications, DM medicine, and chronic diseases. The use of CAM and its type, cost, and duration; sources of CAM-related information; reason for using CAM; usefulness and side effects; CAM use in the future; and doctor consultation before CAM use were also evaluated. Among CAM non-users, the reason for not using CAM and future considerations of CAM were assessed.

RESULTS

A total of 1290 patients were included (27.4%) aged 18-29 years; 726 (56.3%) were women; 554 (42.9%) had a bachelor's degree in education; and 457 (35.4%) were unemployed. The prevalence of CAM use was 528 (40.9%). The most commonly used types were bitter apple 503 (95.3%), cinnamon 341 (64.6%), and ginger 290 (55.1%). The most frequent sources of CAM-related information were friends, families, and neighbors 259 (49.2%), while the most frequent justifications for use were the need for another DM treatment and faith in its advantages. Only 106 (20.1%) of the patients who used CAM disclosed adverse effects; 373 (51.8%) said they would use it again, and 66.1% said they would recommend it to other patients. Only 145 (27.5%) consulted a doctor before using CAM. CAM was more commonly used by patients who were older, women, married, and taking hypoglycemic drugs; whose most recent HbA1c level was 7-10%; and who had dyslipidemia, chronic disease, and a family history of DM.

CONCLUSION

The prevalence of CAM use is high among the Saudi population. Analyzing CAM use is essential in clinical interactions with Saudis with DM. The managing healthcare professionals must educate patients with DM on how to use CAM more effectively and safely.

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.

A Cross-Sectional Assessment of Complementary and Alternative Medicine (CAM) Use among Patients with Chronic Diseases (CDs) in Qassim, Saudi Arabia

This study aims to investigate CAM use among CD patients from Qassim, Saudi Arabia and to compare CAM practice with different demographic and disease characteristics of the participants. A cross-sectional study was conducted among CD patients. During the three-months of data collection period, a total of 377 patients were approached and 208 patients participated in the study, giving a response rate of 55.17%. A p value of <0.05 was considered as significant. Among the study population, 94 (45.2%) patients were CAM users. Diabetes mellitus patients were the majority (48 (51.06%)) followed by hypertensive patients (34 (36.17%)). Spiritual therapies were the most common CAM followed by herbal products. Among CAM users, 41 (19.7%) patients reported disclosing CAM use to their health care providers. Among all the sociodemographic variables, gender (p = 0.029), marital status (p = 0.034) and education level (p = 0.047) were significantly associated with CAM use. In conclusion, the use of CAM among CD patients was relatively high in Qassim. Patients reported using CAM without disclosing to their health care providers which is a major health risk. It is critical to counsel CD patients regarding rational and informed CAM use in order to prevent harmful and unwanted effects.

Perception of Individuals with Diabetes about Efficacy and Safety of Complementary and Alternative Medicines (CAM) in the Jazan Region, Saudi Arabia

Background

CAM is widely accepted for the management of diabetes, and CAM users from many countries showed positive perception towards its use. However, little is known about the perception of individuals with diabetes in Saudi Arabia.

Objectives

This study was aimed to assess the perception of the individuals with diabetes of Jazan region in Saudi Arabia towards CAM.

Methods

An online, anonymous cross-sectional survey was designed and conducted between September 5 and December 31, 2021. Data were collected using 19-item self-report survey from the individuals with diabetes of the Jazan region.

Results

A total of 359 validated responses were received. Approximately, 34% of the participants reported using CAM with modern medicine to control diabetes. Most of the participants reported that CAM is affordable, accessible, acceptable, and effective. Of the study sample, 28% reported using herbal medicine to control diabetes. Significantly, higher percentages of CAM users reported media (42% vs 27%) and friends/family (31% vs 27%) as the primary sources of information about CAM as compared to non-CAM users. Individuals who used CAM for diabetes showed significantly more positive perception (β = 2.386; p=0.001) than those who did not use CAM in the adjusted analysis. Similarly, students had a significantly higher positive perception towards CAM (β = 4.121; p=0.013) compared to employed individuals.

Conclusion

A quarter of the sample of individuals with diabetes used herbal medicine to control diabetes. Individuals who ever used CAM for diabetes showed positive perception towards CAM. However, there is a need of healthcare workers to be involved in educating the individuals with diabetes and the general public in order to use CAM more effectively and safely.

Use of herbal medicine for diabetes mellitus in adults from the central-western region of Mexico

OBJECTIVE

This study aims to assess the prevalence of herbal medicine (HM) use and factors influencing HM usage including the identification of the main plants consumed by patients with type 2 diabetes mellitus (T2DM) in central-western Mexico.

DESIGN

A total of 1862 patients with diabetes were surveyed in public and private hospitals in four states (Guanajuato, Jalisco, Michoacan, and San Luis Potosi) of the central-western region of Mexico. The chi-square test was used to assess associations between HM use and demographic characteristics, such as glucose levels, presence of complications and comorbidities, as well as the selected therapy to treat T2DM.

RESULTS

The prevalence of HM use (59.2%) in patients with T2DM was mainly associated with education level (p = 0.001), time of diagnosis of T2DM (p = 0.004), presence of complications (p < 0.001) and comorbidities (p = 0.018) and the use of insulin (p < 0.001). These patients report a higher consumption of herbal medicine compared to those on glycemic control (p < 0.001). The most frequently used medicinal plants to treat T2DM were nopal (54.9%), moringa (26.7%), and aloe (22.1%).

CONCLUSION

The prevalence of HM use to treat T2DM in west-central Mexico is high (59.2%) and its consumption is mostly carried out without the recommendation of a health professional (91.9%). The use of HM increases mainly when the patient uses insulin, during complications of the disease or in patients with an inadequate glycemic control.

Global prevalence and types of complementary and alternative medicines use amongst adults with diabetes: systematic review and meta-analysis

AIM

This study aimed to undertake a systematic review and meta-analysis of global prevalence and types of complementary and alternative medicine (CAM) use amongst adults with diabetes.

METHODS

Nine databases, including MEDLINE and EMBASE, were searched for studies published between 2009 and 2019 which included extractable data for CAM use in adult patients with diabetes. Study characteristics, types of CAM, and overall and subgroup prevalence data in relation to CAM use were extracted. Meta-analysis of aggregate level data on prevalence and prevalence ratios (PRs) was performed using a random effects model.

RESULTS

From the 38 studies included in the review, a total of 37 types of CAM and 223 types of herbs were identified. Pooled prevalence of CAM use was 51%. A wide variation in prevalence rates (predictive interval 8-93%) was observed. In the context of high heterogeneity, we found no evidence that CAM use was associated with gender, chronicity or type of diabetes. Approximately one third of patients did not disclose their use of CAM to healthcare professionals (95% PrI 25%, 97%). Herbal medicines, acupuncture, homoeopathy and spiritual healing were the common CAM types reported.

CONCLUSIONS

A wide variation in prevalence of CAM use by patients with diabetes was identified. Healthcare professionals should be aware of their patients' use of CAM to ensure treatment optimization, avoid herb-drug interactions and promote medication adherence in diabetes. Diabetic reviews and clinical guidelines should incorporate exploration of patient use of CAM as many patients do not proactively disclose the use of CAM to their healthcare professionals.

REGISTRATION

The protocol for this study was registered with the Centre for Review and Dissemination (CRD). Protocol registration number CRD42019125036.

The knowledge, attitude, practice and predictors of complementary and alternative medicine use among type 2 diabetes mellitus patients in Indonesia

OBJECTIVE

The prevalence of complementary and alternative medicine (CAM) usage among patients with type 2 diabetes mellitus (T2DM) in Indonesia is high. However, to date, little is known about why Indonesian T2DM patients choose CAM therapies, how their knowledge, attitude and practice (KAP) of CAM affects their choices, or how demographics correlate with patient choices. Therefore, this study aimed to investigate the KAP and predictors of CAM usage in T2DM patients in Indonesia.

METHODS

This was an observational, cross-sectional study. Patients were interviewed using a questionnaire. Chi-square tests or Fisher's exact tests were used to compare demographic and clinical data, as well as KAP assessments, between T2DM patients who use and do not use CAM. Multivariate logistic regression analyses were used to investigate predictors of CAM usage.

RESULTS

A total of 628 T2DM patients were enrolled in the study. CAM therapies were used by 341 patients (54.3%). The most common therapies were herbs and spiritual healing, used by 100.0% and 68.3% of CAM-using patients, respectively. CAM therapies were frequently recommended by family members (91.5%), and CAM users had significantly more knowledge and more positive attitudes toward CAM therapies than nonusers. Among users, 66% said they would not follow their healthcare providers' instructions to not use CAM therapies, and 69.5% said they would not disclose their plan to use CAM therapies with their healthcare provider. Neither demographic nor clinical characteristics were associated with CAM use. The factors that best predicted the use of CAM therapies were their availability and low cost (odds ratio [OR] = 4.59; 95% confidence interval [CI]: 3.01-7.01), the belief that CAM therapies were safe (OR = 2.04; 95% CI: 1.40-2.95), the belief that CAM therapies could help with diabetes control (OR = 1.75; 95% CI: 1.15-2.66), and the belief that CAM therapies could help maintain physical health (OR = 1.68; 95% CI: 1.13-2.49).

CONCLUSION

CAM therapy users were more knowledgeable and had more positive attitudes toward CAM, but most of them chose not to disclose their CAM use to their healthcare providers. CAM use in Indonesia was associated with its accessibility, affordability, safety and effectivity, but not with any demographic or clinical characteristics. This study provided new evidence and insights for nurses and physicians in Indonesia that will help to design educational programs about the safety and efficacy of CAM therapies.

Investigation of attitude, awareness, belief, and practice of complementary and alternative medicine among type 2 diabetic patients: a cross sectional study

Objective

This study aimed to evaluate the awareness, attitude, belief, and practice of complementary and alternative medicine (CAM) among type 2 diabetes patients.

Methods

This cross-sectional study was conducted on 1000 type 2 diabetic patients in 2019. The stratified sampling method was used for selecting samples from those who had the inclusion criteria. Data were analyzed using SPSS 24 software.

Results

In this study, the mean (standard deviation) of attitude score was 28.21 (3.65) (out of 45), and 64.86 % of patients had a positive attitude towards using CAM. Most of the patients (71.56 %) reported that having very little awareness of CAM modalities. The most commonly used CAM included nutritional therapy (97.1 %), exercise (93.3 %), and vitamin supplements (24.1 %). The most effective CAM modalities from the perspective of patients were nutritional therapy (36.38 %), herbal medicines (35.12), and exercise (21.53), respectively. Results showed that participants getting information about CAM from healthcare providers (58.6 %), internet (55.6 %), friends (36 %), and educational manuals (25.7 %), respectively. The most important reasons for diabetic patients to use the CAM were the treatment of the disease (39.6 %), fear of the side effects of chemical drugs (34.9 %), and increased body energy and ability (9.1 %).

Conclusions

The results showed that patients have a positive attitude, and most of them have experience of using CAM. However, most patients report that they have rather little awareness in this field. Thus, healthcare providers must provide patients with the necessary information so that these modalities are used correctly.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-021-00769-4.

The Utilization of Complementary and Alternative Medicine among Saudi Older Adults: A Population-Based Study

BACKGROUND

Complementary and alternative medicine (CAM) is an integral part of patients' therapeutic experience worldwide. Among Saudi older adults, less is known about CAM utilization.

OBJECTIVES

To determine the prevalence, patterns, and factors associated with CAM utilization among SOA.

METHODS

In the Saudi National Survey for Elderly Health (SNSEH), subjects were asked about CAM use during the last twelve months before the interview. CAM use was defined as any use of herbal products, acupuncture, bloodletting, cauterization, medical massage, bones manual manipulation, honey, or religious rituals. Demographic characteristics included gender, age, marital status, region, educational level, and residence area. In addition, multiple comorbidities were included as possible factors that may be associated with CAM use. Multivariable logistic regression was used to explore factors associated with CAM utilization. All statistical analyses were done using STATA v.14.

RESULTS

Out of 2946 respondents, 50.4% were males, the mean age was 70.3 ± 8.3 years, and 70% were illiterate. CAM use was prevalent (62.5%). The most common CAM types were herbal products (25.4%), acupuncture (21.2%), bloodletting (12%), honey (9.5%), cauterization (7.4%), medical massage and bones manual manipulation (4%), and traditional bone setting (2.1%). In the multivariable regression, age, gender, and marital status did not have an impact on the odds of using CAM. Subjects from rural areas were 2.92 times more likely to use CAM compared with subjects in urban areas (OR = 2.92; 95%CI: 2.28-3.75). Subjects with metabolic disorders (OR = 0.50; 95% CI: 0.42-0.60) or kidney disease were less likely to use CAM (OR = 0.30; 95%CI: 0.14-0.64). About pain, CAM is used more in neck pain (OR = 1.69; 95%CI: 1.30-2.21) and also used in back pain (OR =  1.22; 95%CI: 1.03-1.46).

CONCLUSIONS

CAM use was very prevalent among SOA. Clinicians and pharmacists must ask about CAM use among older adults as many of CAM may interact with patients medications.

Prevalence and predictors of using complementary and alternative medicine among diabetic patients in Taif city, Saudi Arabia

Background:

Saudi Arabia has the second-highest rate of diabetes in the Middle East. Herbal treatment is the most used complementary and alternative therapy among Saudi diabetic patients. Little is known about the use of complementary and alternative medicine among diabetic patients who reside in Taif city.

Method:

This study evaluated the magnitude and correlates of complementary and alternative medicine (CAM) use among diabetic patients attending diabetic clinics and primary healthcare in two governmental hospitals, namely, Prince Mansour Military Hospital (PMMH) and National Gourd Hospital (NGH) in Taif city.

Results:

CAM prevalence was 33.7%, of whom 87.3% did not consult a doctor before use and 43.2% had more than one source of information while 62.7% used more than one CAM method. Around 49.2% reported that it is very useful, and 72.9% did not notice any side effect from its use. In addition, 47.5% would recommend CAM to other diabetic patients. All (100%) reported using bitter apple, 66.1% reported using cinnamon, 55.1% used ginger, 35.6% took fenugreek, and 21.2% reported using Garlic as an only CAM. Female gender, family history, diabetic complications, and longer duration of diabetes were associated with the increased use of CAM.

Discussion and Conclusion:

CAM use by diabetic patients in Taif is prevalent. Health education and the safe use of CAM is much needed. Appropriate efforts from the government to integrate CAM into conventional diabetes treatment should be considered.

MSC-derived exosomes attenuate cell death through suppressing AIF nucleus translocation and enhance cutaneous wound healing

Background

Skin wounding is very common and may be slow to heal. Increasing evidence shows that exosomes derived from mesenchymal stem cells (MSCs) dramatically enhance skin wound healing in a paracrine manner. However, the mechanism underlying this phenomenon has not yet been elucidated. Thus, the objective of the present study was to identify the signaling pathways and paracrine factors by which MSC-derived exosomes promote de novo skin tissue regeneration in response to wound healing.

Methods

In vitro and in vivo skin wound healing models were created by treating immortalized human keratinocytes (HaCaT) with hydrogen peroxide (H₂O₂) and excising full-thickness mouse skin, respectively. Exosomes were extracted from human umbilical cord Wharton’s jelly MSCs (hucMSC-Ex) by ultracentrifugation of cell culture supernatant.

Results

The hucMSC-Ex treatment significantly increased HaCaT cell proliferation and migration in a time- and dose-dependent manner, suppressed HaCaT apoptosis induced with H₂O₂ by inhibiting nuclear translocation of apoptosis-inducing factor (AIF) and upregulating poly ADP ribose polymerase 1 (PARP-1) and poly (ADP-ribose) (PAR). The animal experiments showed that relative to hucMSCs, hucMSC-Ex attenuated full-thickness skin wounding by enhancing epidermal re-epithelialization and dermal angiogenesis.

Conclusions

These findings indicated that direct administration of hucMSC-Ex may effectively treat cutaneous wounding and could be of great value in clinical settings.

Spiritual and Religious Healing Practices: Some Reflections from Saudi National Center for Complementary and Alternative Medicine, Riyadh

Traditional practices constituting spiritual and religious (S/R) healing are an important component of the holistic healthcare model and are used in health, well-being, and treating a variety of diseases around the world. The main focus of this review is to summarize the Complementary and Alternative Medicine (CAM) studies that especially target S/R healing practices in Saudi Arabia (SA) and discuss the results in light of relevant international literature. From year 2013-2017, electronic searches of PubMed, OvidSP, Google Scholar, and two publishing housing Web sites (Sciencedomain.com and Dove Medical Press.com) were made using key words and Boolean operators and retrieved thousands of published papers from peer-reviewed journals. Two independent reviewers decided to include a total of 108 articles: 48 from SA and 60 from other international literature. The sociodemographic variables of the participants varied in local studies and were comparable with international data. The frequency and types of religious and spiritual practices reported in local and international zones varied in accordance with religious belief, gender, age, education, and prevalent chronic diseases. Most of professionals and practitioners showed fairly good knowledge and positive attitude toward spiritual and religious practices used in diverse clinical and non-clinical situations across the world. Furthermore, it was observed that in the international scenario, S/R researches using specific religious screening tools have been conducted on different aspects of clinical application including self-care, social cohesion, negative impact, and child development, whereas regional studies targeting varied participants mainly focused on the epidemiological trends of S/R therapies in Saudi Arabia. CAM practitioners and public tend to show great interest in prescribed and self-use of religious and spiritual therapies across the world because of multiple dynamic forces, including positive effects on health, sense of well-being and disease control, cost-effectiveness, easy access to services, and improvement in quality of life. Further studies are needed to assess the effectiveness of different types of religious and spiritual therapies and practices used in specific diseases, their role in promotion of health and well-being, and prevention of diseases nationwide and across the world. Besides integration of S/R into mainstream treatment modalities, medical education curriculum, continuous medical education, and training programs are needed for bridging the knowledge, attitude, and practice gaps concerning CAM in targeted population groups such as medical professionals, CAM practitioners, medical students, public and traditional healers, not only in SA but also around the world.

Herbal medicine from the perspective of type II diabetic patients and physicians: what is the relationship?

Background

Diabetes mellitus (DM) is a major public health problem and one of the most challenging diseases worldwide. According to the World Health Organization (WHO), the Kingdom of Saudi Arabia (KSA) has the second highest rate of diabetes in the Middle East and seventh highest globally. Some diabetic patients may prefer to use alternative approaches such as herbal remedies to control their blood glucose level and this study aims to assess the prevalence of herbal usage and to evaluate users’ and doctors’ knowledge, attitudes and beliefs about herbal medicine as well as the patient/doctor relationship in this regard.

Method

A cross-sectional survey was conducted in several hospitals and medical centres in Makkah, KSA, between January and March 2019. Around 289 type II diabetic patients and 105 doctors were interviewed.

Results

We found that 68% of the participants were frequent consumers of herbal remedies, especially cinnamon, ginger and fenugreek. Patients’ knowledge of herbal usage was mainly gleaned from family and friends as well as social media, and we found that many (71.4%) did not bother to consult or inform their doctors about their choice to self-medicate with herbs. Patients had no concerns regarding the efficacy and safety of herbal usage use in diabetes, as around half of the participants believe that herbal medicine is effective (54%) and safe (46%) for treating symptoms of diabetes. Two-thirds of the doctors (66%) routinely ask patients whether they use herbs for their condition. Although 25% of the doctors took a positive view of herbal medicine in relation to diabetes, others expressed concerns with the rise in herb use and want to see more attention paid to safety aspects.

Conclusion

The study concludes that herbal remedies are commonly used by diabetic patients and that a gap exists in the relationship between patients and doctors concerning the disclosure of herbal remedy use and views on its safety.

Interactions Between Gut Microbiota, Host, and Herbal Medicines: A Review of New Insights Into the Pathogenesis and Treatment of Type 2 Diabetes

Herbal medicines (HMs) are a major subset of complementary and alternative medicine. They have been employed for the efficient clinical management of type 2 diabetes mellitus (T2DM) for centuries. However, the related underlying mechanisms still remain to be elucidated. It has been found out that microbiota is implicated in the pathogenesis and treatment of T2DM. An interplay between gut microbiota and host occurs mainly at the gastrointestinal mucosal barrier. The host movements influence the composition and abundance of gut microbiota, whereas gut microbiota in turn modulate the metabolic and immunological activities of the host. Intestinal dysbiosis, endotoxin-induced metabolic inflammation, immune response disorder, bacterial components and metabolites, and decreased production of short-chain fatty acids are considered significant pathogenic mechanisms underlying T2DM. The interaction between gut microbiota and HMs during T2DM treatment has been investigated in human, animal, and in vitro studies. HMs regulate the composition of beneficial and harmful bacteria and decrease the inflammation caused by gut microbiota. Furthermore, the metabolism of gut microbiota modulates HM biotransformation. In this review, we have summarized such research findings, with the aim to improve our understanding of the pathogenesis and potential therapeutic mechanisms of HMs in T2DM and to provide new insights into specific targeted HM-based therapies and drug discovery.

Knowledge, Attitude, and Practices of Complementary and Alternative Medication Usage in Patients of Type II Diabetes Mellitus

Introduction Complementary and alternative medicine (CAM) is becoming popular among individuals affected by chronic diseases, such as diabetes mellitus. We aimed to determine the knowledge, attitude, and practices of complementary and alternative medicine use among type 2 diabetes patients in Karachi, Pakistan. Methods An observational, prospective, cross-sectional study was conducted in the institute of diabetology in a tertiary care hospital in Pakistan from 1st March 2018 till 31st August 2018. All patients of type 2 diabetes mellitus attending the clinic for routine follow-up visits during the study period were interviewed. Their demographic characteristics, clinical data, and knowledge, attitude, practices towards use of CAM products were assessed. Data was managed using SPSS for Windows version 16.0 (SPSS Inc, Chicago, IL). Results CAM therapies were being used by 151 (57.8%) individuals. Herbs (n = 121; 80.1%), specific diets (n = 98; 64.9%), and cupping (n = 68; 45.0%) were the most readily utilized CAM practices. CAM practices were associated with diabetes-related complications [p < 0.000; Odds Ratio (OR) 2.57; Confidence Interval (CI) 1.53, 4.34], poor glycemic control (p < 0.000; OR 0.29; CI 0.17, 0.5), lack of trust in pharmaceutical products (p < 0.000; OR 5.08; CI 2.28, 11.32), poor patient-doctor relationship (p = 0.06; OR 1.47; CI 0.26, 8.17), CAM products being readily available and cheaper (p < 0.000; OR 6.1; CI 3.02, 12.32), and belief that CAM products have fewer side effects (p < 0.000; OR 12.32; CI 6.83, 22.22) and can help in diabetes control (p < 0.000; OR 35.76; CI 16.79, 76.15). Conclusion Use of complementary medicine products among Pakistani diabetic population is high. Herbs and specific diets were common modes of CAM practices. Use of CAM showed significant association with female gender, older age, unemployment, longer duration of diabetes, diabetes-related complications, and poor glycemic control.

Knowledge and awareness of diabetes mellitus and its risk factors in Saudi Arabia

OBJECTIVES

To summarize available peer-reviewed publications about public knowledge and awareness of diabetes mellitus (DM) among the population of Saudi Arabia.

METHODS

We followed the standard reporting guidelines outlined in the PRISMA statement for the preparation of this systematic review. In February 2018 we conducted literature searches of PubMed, Scopus, BIOSIS Citation Index, and Web of Science using the following keywords: "Knowledge" OR "Awareness" AND "Diabetes Mellitus" AND "Saudi Arabia." Records were screened, and relevant studies were selected and synthesized narratively.

RESULTS

Nineteen articles are included in our systematic review. These studies included the following populations: DM patients (n=13), healthcare workers (n=3), medical students (n=1), secondary school students (n=1), and general population (n=1). Most studies found a lack of public awareness of the risk factors and complications of DM. Among medical students and healthcare workers, knowledge about the epidemiology of the disease and angle of insulin injection was deficient.

CONCLUSION

This review highlights the need for increased knowledge and awareness of DM among the Saudi population. The means of improving knowledge and awareness of DM needs to be integrated into existing healthcare systems and processes to better inform patients, families and communities about this chronic disease.

Pregnant women's use and attitude toward herbal, vitamin, and mineral supplements in an academic tertiary care center, Riyadh, Saudi Arabia

BACKGROUND

Herbal medicine has been widely utilized by pregnant women despite the limited available evidence regarding the safety and efficacy of that practice. The current available studies, from different countries, estimated that the use of herbal medicine during pregnancy range from 7% up to 96%. The aim of this study is to determine the prevalence, attitude, source of information, and reasoning behind the use of herbal medicine among pregnant women in Saudia Arabia.

METHODS

A cross-sectional study conducted using a convenience sample including pregnant women who visited the obstetric clinics at King Abdulaziz Medical City in Riyadh, Saudi Arabia. A survey was administered in order to evaluate the prevalence and perception toward herbal medicine use among pregnant women in Saudi Arabia.

RESULTS

A total of 297 pregnant women completed the survey. The results showed that 56% of the respondents have used some type of herbal medicine during their pregnancy. Olive oil was utilized in 26% of the respondents followed by cumin 20% and garlic 15%. In addition, 37% of the respondents used herbal medicine by their own initiative, while 33% and 12% used herbal medicine based on recommendations from their families and friends, respectively. Furthermore, 19% of the respondents reported a positive attitude toward herbal medicine use during pregnancy. In addition, the percentage of women with positive attitude was marginally higher among respondents with lower educational level.

CONCLUSION

The prevalence of using herbal medicine is considerably high among pregnant women in Saudi Arabia. Unfortunately, the majority of the users relied on informal sources to use herbal medicine during pregnancy.

A Descriptive Review of the Prevalence and Usage of Traditional and Complementary Medicine among Saudi Diabetic Patients

Diabetes mellitus represents a major burden in Saudi Arabia where seven million (20% of population) are living with diabetes. This article reviews the literature on usage of traditional and complementary medicine (T&CM) therapies among Saudi diabetic patients, focusing in particular on identifying the prevalence as well as discussing their safety and efficacy. Three databases (PubMed, Cochrane, and ScienceDirect) were searched prior to December 10, 2017, for articles published in peer-reviewed journals that reported primary data on the use of traditional and complementary medicine therapies among diabetic patients in Saudi Arabia. Six studies were selected according to the inclusion/exclusion criteria. In conclusion, the prevalence of use of T&CM therapies among diabetics in Saudi Arabia was 32.18%. This review identified that the most used T&CM therapy among diabetics was herbal treatment. The most used herbs were fenugreek, black seeds, neem, myrrh, helteet, harmel, and aloes. There is insufficient or little evidence to support the efficacy of the most identified herbs and therapies. This review is raising the safety concerns about the used herbs and complementary therapies which were commonly used without any medical consultation.

Diabetes mellitus carries a risk of esophageal cancer: A meta-analysis

BACKGROUND

Many studies have showed that diabetes mellitus (DM) might be a risk factor for certain types of cancers. However, there are still inconsistent results on the effects of DM on the risk of esophageal cancer (EC). The objective of this study is to investigate the association and to quantify the correlation between DM and EC by a meta-analysis.

METHODS

The initial search identified 339 articles. Those publications that did not report the exact number of EC cases were removed. Finally, 13 meaningful studies were extracted from the databases of PubMed, MEDLINE, and Web of Science. All pooled analyses of risk ratios (RRs) and 95% confidence intervals (CIs) were assessed by a random-effect or fixed-effect model. Subgroup analysis was implemented on the basis of the sex or ethnicity. I value was used to assess heterogeneity, and funnel plot analysis was for publication bias.

RESULTS

The result showed that there was a positive correlation between type 2 diabetes mellitus (T2DM) and EC risk (RR = 1.28, 95% CI: 1.12-1.47, P < .001). Subgroup analysis based on gender showed that male was an important risk factor for EC (RR = 1.53, 95% CI: 1.44-1.62, P < .001), but female was not (RR = 1.23, 95% CI: 0.41-3.69, P = .71). In addition, subgroup analysis based on ethnicity showed that DM was significantly correlated to EC in North America subjects (RR = 1.39, 95% CI: 1.31-1.47, P < .001), and in Europe subjects (RR = 1.37, 95% CI: 1.02-1.83, P = .04), whereas no correlation was found in Asian subjects (RR = 0.98, 95% CI: 0.50-1.95, P = .96). Furthermore, DM had a correlation to an increased risk of esophageal adenocarcinoma (EAC) (RR = 1.43, 95% CI: 1.35-1.51, P < .001).

CONCLUSION

This meta-analysis indicates that DM is positively correlated to EC. However, the results should be interpreted with caution because of the limitations on potential clinical confounding factors in each study included in this meta-analysis.

Anemia, bilirubin, and cardiovascular autonomic neuropathy in patients with type 2 diabetes

To investigate the relationship among anemia, physiological serum bilirubin levels, and cardiovascular autonomic neuropathy (CAN) in subjects with type 2 diabetes. In total, 2230 subjects with type 2 diabetes were evaluated in this cross-sectional study. CAN was diagnosed with a cardiovascular reflex test. The prevalence of anemia was greater in subjects with CAN. In multivariable analysis, the relationship between anemia and CAN remained statistically significant after adjusting for the risk factors (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.07-1.80, P = .015). Additional adjustment for serum bilirubin concentrations abolished this relationship (OR 1.20, 95% CI 0.91-1.58, P = .189). Anemia is positively associated with the prevalence of CAN in subjects with type 2 diabetes. In addition, our results suggest that the putative increased CAN risk associated with anemia might be mediated by a correlated decrease in serum bilirubin levels.