Complementary and alternative medicine use in diabetes: Prevalence, factors associated with use and clinical implications

Alzahrani, Abdulaziz (2022). Complementary and alternative medicine use in diabetes: Prevalence, factors associated with use and clinical implications. University of Birmingham. Ph.D.

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Diabetic patients require special care in terms of treatment, diet and/or lifestyle; the delicate balance of a treatment regimen can be influenced by several factors, including the use of complementary and alternative medicine (CAM). CAM includes herbal and dietary supplements, traditional medicine, body therapy, e.g. massage and yoga and mind therapy, e.g. meditation and reflexology. This research was carried out over five phases. The systematic review of prevalence offered an updated view of the magnitude of CAM use by diabetic patients and listed all CAM types used by diabetic patients available in previous literature. No previous study had synthesised factors associated with CAM use in diabetes using a systematic review methodology. The systematic review of factors associated with diabetic patients’ CAM use synthesised factors reported in the literature for a comprehensive understanding of factors important to patients that drives them to use CAM. The subsequent study on patient online forums analysed discussions that diabetic patients have out with formal research or healthcare settings and hence offered novel insight into the factors associated with CAM use in diabetes.. The subsequent qualitative studies addressed the dearth of literature in Saudi Arabia regarding patient and healthcare professional perspectives on CAM use. The qualitative interviews with diabetic patients explored in-depth, their beliefs around CAMs. In particular, patient perspectives related to the cultural and religious significance of some CAM forms used in diabetes in Saudi Arabia were, to the researcher’s knowledge not reported in such depth in previous literature compared to the findings of this study. A systematic review and meta-analysis of the available literature to identify the global prevalence of CAM use amongst diabetic patients was undertaken. This review also aimed to produce a comprehensive list of CAM types used by diabetic patients as reported in the peer-reviewed literature. The second phase involved a systematic review to identify the factors associated with CAM use by diabetic patients. The third phase studied diabetic patients’ communications in patient online discussion forums. The fourth phase included qualitative semi-structured interviews with diabetic patients to explore their views and experiences regarding their CAM use. The fifth phase included qualitative semi-structured interviews with healthcare professionals involved in the care of diabetic patients to explore their perspectives on CAM use by their patients. The Theoretical Domains Framework (TDF) was used to design data collection materials and inform the analysis.
The first systematic review which included 38 studies, identified a pooled global prevalence of CAM use amongst diabetic patients of 51% (predictive interval 8%-93%), and listed a total of 37 types of CAM and 223 types of herbs that diabetic patients use. The review showed up to 2/3rd of users do not disclose CAM use to their healthcare providers.
From the second systematic review of 43 studies from 28 countries, a total of 84 factors associated with CAM use were identified and were mapped to the TDF. Key factors identified were related to treating and relieving symptoms, accessibility and affordability compared to physician visits and modern medicines, ‘social influences’ from family members, friends, religious and spiritual scholars. CAM users also reported lack of trust in modern medicines and perceived CAM to be safer and free from adverse effects.
Phase three of the study was not limited to specific country and identified and reviewed data from 22 diabetes online forums containing 77 threads with 1156 posts from patients. The study showed that diabetic patients seek other users’ experience with using CAM for treatment of diabetes and offer instructions to one another on how to use CAM. Feeling stressed, frustrated or overwhelmed with the condition and prescribed medications was often linked to their decisions to use CAM. They described that healthcare professionals were often unaware or unable to help in regard to their queries around CAM. They sought and shared studies to support or refute claims around perceived benefits and harms.
Subsequent qualitative interviews with patients and healthcare professionals in Saudi Arabia identified barriers to effective communication between diabetic patients and their healthcare professionals regarding CAM use. These included lack of knowledge amongst both patients and healthcare professionals as well as cultural and regulatory barriers. Such limited discussion about CAM made diabetic patients vulnerable to financial exploitation by some CAM providers. Patients described substituting doses of prescribed treatments with CAM or resorting to CAM use as a standalone treatment often to avoid adverse events or due to perceptions that prescribed treatments contributed to disease chronicity. Both patients and healthcare professionals associated some CAM forms with cultural and religious significance.
In conclusion, this study shows that CAM use in diabetes is widespread. However its consideration in clinical consultations remains limited and this research calls for acknowledgment of such widespread amongst patients by healthcare professionals, clinical guidelines and regulatory bodies. Healthcare professionals should be aware of their diabetic patients' use of CAM to ensure treatment optimization and medication adherence. The gap in communication between diabetic patients and healthcare professionals needs to be improved to optimise treatment outcomes through flexible consultation time, overcoming legal barriers, accommodating consultation protocols and culturally sensitive and evidence-based information provision to both diabetic patients and healthcare professionals. Alleviating patients’ concerns and reluctance to use prescribed treatments is imperative to achieve therapeutic goals.

Type of Work: Thesis (Doctorates > Ph.D.)
Award Type: Doctorates > Ph.D.
Licence: All rights reserved
College/Faculty: Colleges (2008 onwards) > College of Medical & Dental Sciences
School or Department: School of Pharmacy
Funders: Other
Other Funders: Saudi Ministry of Education
Subjects: R Medicine > RS Pharmacy and materia medica


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