Complementary and alternative medicine use among diabetic patients in Africa: a Kenyan perspective

Complementary and alternative medicine use among diabetic patients in Africa: a Kenyan perspective

 

Duncan Mwangangi Matheka^1,2,&, Alessandro Rhyll Demaio^2,3,4

 

¹Department of Medical Physiology, University of Nairobi, Kenya, ²Young Professionals Chronic Disease Network, ³Copenhagen School of Global Health, University of Copenhagen, ⁴Harvard Global Equity Initiative, Harvard Medical School, USA

 

 

^&Corresponding author
Duncan Mwangangi Matheka, Department of Medical Physiology, University of Nairobi, P.O. Box 30197-00100 Nairobi, Kenya

 

 

 

 

The prevalence of diabetes mellitus (DM) worldwide is projected to rise to 552 million (representing 10% of the global adult population) by 2030 up from 366 million in 2011 [1]. The burden is worse in the developing world which represents over 80% of cases [1, 2].

 

In DM management, lifestyle measures, oral glucose-lowering drugs and insulin are the conventional therapies. The latter two are, however, expensive or even unavailable to many patients in developing countries [3], and are sometimes associated with adverse effects [4]. Consequently, some patients opt for complementary and alternative medicine (CAM) to manage their DM. The prevalence of CAM use among people living with DM is estimated to be as high as 80% in Africa [5, 6].

 

 

Commonly used CAM therapies among diabetic patients in Africa include herbal medicines, nutritional products, spiritual healing and relaxation techniques [7-10]. These CAM therapies are extensively used by patients as adjuvant or as replacement treatment to the conventional prescribed drugs [11-14]. CAM use in Africa is amplified by the presence of traditional healers, with estimates of one traditional healer present to every 200 people [15]. These traditional healers make selective use of CAM, biomedical knowledge and language to enhance the perceived effectiveness of their treatments [15].

 

The use of CAM in Africa has been associated with cultural beliefs, age of patient, duration of DM, degree of complications, and advice from family and friends [16, 17]. Most importantly, the inaccessibility and shortcomings in conventional healthcare provision in Africa contribute to the high use of CAM [3].

 

A major concern is that diabetic patients may replace clinically proven conventional diabetes treatments with CAM agents [18, 19]. These patients rarely disclose their CAM practices to their health care providers (HCPs) [20], an issue which warrants particular attention. There is a potential risk of drug interaction when these agents are used as adjuvants to allopathic medicine. They may also interfere negatively with glycemic control, and cause adverse effects and additional complications [6, 15, 19, 21]. It is a well-known fact that most CAM agents contain active ingredients for which appropriate doses and side effects have not been determined. They are therefore likely to be administered at inconsistent doses, with the potential for fatal health effects and mortalities [17].

 

 

A number of constraints exist in the control of CAM use in Africa. For instance, there is lack of integration of CAM therapies into African mainstream health care systems. This is despite the World Health Organization (WHO) recommendation to "integrate traditional and CAM therapies into national health care systems" [6].

 

Another major concern is the lack of regulation on CAM use in Africa and other developing countries, and therefore exposing the population to potential harm. There exists limited quality assurance with most CAM regulatory processes falling outside the scope of most government drug and therapeutic agencies in Africa. For instance, the registration of herbalists in Kenya is done by the Ministry of Social services, but in essence most of the traditional herbalists are not even aware of this.

 

There is also limited research on CAM use by people with diabetes in developing countries including Kenya. Some CAM products may also be beneficial and safe; but the lack of randomized controlled trials makes their use controversial [21].

 

HCPs are also not aware that so many of their diabetic patients use CAM therapies. HCPs should therefore have this in mind, and routinely take a thorough history to document any such therapies and discuss these practices with their patients in order to safeguard their health. HCPs should educate their patients on the importance of adherence, controlling blood sugars and avoidance of potentially dangerous CAM.

 

 

CAM is widely used among diabetic patients as an adjunct to conventional therapy in developing countries. This could result in ineffective diabetes management and cause adverse effects, especially since the CAM use is rarely disclosed to HCPs. Empirical evidence, integration and stringent national regulatory safe-guards should guide the safe and appropriate CAM use and sales. Legislation to govern CAM use is therefore necessary and inevitable. Above all, conventional medications should be easily accessible. HCPs should also be aware of CAM use, and educate their patients accordingly. There is a need for urgent multi-sectoral action to streamline CAM use among patients in Africa and other developing countries.

 

 

The authors declare no competing interests.

 

 

The authors worked jointly in preparing this manuscript. Both authors have read and approved the final version of the manuscript.

 

 

1. International Diabetes Federation. Diabetes Atlas. 5th Ed. 2011. http://www.idf.org/diabetesatlas/news/fifth-edition-release. Accessed 30th April 2013.


2. Dirk LC, Henrik F, Mwaniki DL, Kilonzo B, Tetens I, Boit MK. Prevalence of glucose intolerance and associated risk factors in rural and urban populations of different ethnic groups in Kenya. Diab Res Clin Pract. 2009; 84(3): 303-10. PubMed | Google Scholar


3. Mendis S, Fukino K, Cameron A, Laing R, Filipe A, Khatib O, Leowski J, Ewen M. The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries. Bull World Health Org. April 2007; 85(4): 279-88. PubMed | Google Scholar


4. Sinha A, Formica C, Tsalamandris C, Panagiotopoulos S et al. Effects of insulin on body composition in patients with insulin-dependent and non-insulin dependent diabetes. Diabet Med. Jan 1996; 13(1): 40-46. PubMed | Google Scholar


5. Chang H, Wallis M, Tiralongo E. Use of complementary and alternative medicine among people living with diabetes: literature review. J Adv Nurs. May 2007; 58 (4): 307-319. PubMed | Google Scholar


6. World Health Organization (WHO). Traditional Medicine Strategy. 2002. www.who.int/medicines/publications/traditionalpolicy/en/. Accessed 30th April 2013.


7. Matheka DM, Kiama TN, Alkizim FO, Bukachi F. Glucose-lowering effects of Momordica charantia in Healthy rats. Afr J Diab med. 2011; 19(2): 15-19. PubMed | Google Scholar


8. Matheka DM, Alkizim FO. Complementary and alternative medicine for type 2 diabetes mellitus: Role of medicine herbs. J Diab Endocrinol. 2012; 3(4): 44-56. PubMed | Google Scholar


9. Mehrotra R, Bajaj S, Kumar D. Use of complementary and alternative medicine by patients with diabetes mellitus. Natl Med J India. 2004; 17(5):243-245. PubMed | Google Scholar


10. Matheka DM, Alkizim FO, Kiama TN, Bukachi F. Glucose-lowering effects of Momordica charantia (Karela) extract in diabetic rats. Afr J Pharmacol Ther. 2012; 1(2): 62-66. PubMed | Google Scholar


11. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med. 28 Jan 1993; 328(4): 246-52. PubMed | Google Scholar


12. MacLennan AH, Wilson DH, Taylor AW. Prevalence and cost of alternative medicine in Australia. Lancet. 1996; 347(9001):569-73. PubMed | Google Scholar


13. Fischer P, Ward A. Complementary medicine in Europe. Brit Med J. 9 July 1994; 309(6947):107-11. PubMed | Google Scholar


14. Malhotra S, Karan RS, Pandi P, Jain S. Drug related medical emergencies in the elderly: Role of adverse drug reactions and non-compliance. Postgrad Med J. 2001; 77(913):703-7. PubMed | Google Scholar


15. Awah P. Diabetes and traditional medicine in Africa. Diab Voice. 2006; 51(3): 24-26. PubMed | Google Scholar


16. Coulter I, Willis E. The rise and rise of complementary and alternative medicine: a sociological perspective. Med J Aust. 2004; 180(11):587-89. PubMed | Google Scholar


17. International Diabetes Federation. Diabetes Education Modules. 2011; 2nd Edition. Brussels, Belgium. IDF. Google Scholar


18. Ernst E. The role of complementary and alternative medicine. Brit Med J. 4 Nov 2000; 321(7269): 1133-35. PubMed | Google Scholar


19. Egede LE. Complementary and alternative medicine use with diabetes. Geriatrics Times. 2004; 5: 54-59. PubMed | Google Scholar


20. Khalaf AJ, Whitford DL. The use of complementary and alternative medicine by patients with diabetes mellitus in Bahrain: a cross-sectional study. BMC Complement Alt Med. 2010; 10:35.Epublication. PubMed | Google Scholar


21. Barnes J. Quality, efficacy and safety of complementary medicines: Fashions, facts and the future. Part II: Efficacy and safety. Br J Clin Pharmacol. April 2003; 55(4):331-40. PubMed | Google Scholar


22. Matheka DM, Mokaya J, Alessandro RD. Unregulated Complementary and Alternative Medicine use among diabetic patients in Africa: A call for action. Afr J Diab Med. 2012; 20(2): 38. PubMed | Google Scholar