Traditional, Complementary, and Alternative Medicine use among patients with type 2 Diabetes Mellitus in Nepal

Abstract

Background: Globally, both the general public and people with chronic illnesses have shown a marked growth in interest in Traditional, Complementary, and Alternative Medicine (TCAM) use in recent decades. There are various causes and contributing factors for patients with type 2 diabetes mellitus to consider using TCAM, however, little is known about TCAM use among patients with type 2 diabetes mellitus in Nepal. Methods: A cross-sectional study was conducted from April to May 2022 on type 2 diabetes mellitus patients at the outpatient section of Lumbini Zonal Hospital, in southwest Nepal. Face-to-face interviews with 401 patients were conducted using a semi-structured questionnaire that had four sections: general health and diabetes-related medical features, patients' attitudes and perceptions during the COVID-19 pandemic, TCAM usage, and socio-demographic characteristics. Data were analyzed using descriptive statistics and the Chi-square test by using SPSS ver. 26.0 and further logistic regression was performed to determine the correlates of TCAM use. Results: Out of 401 participants, 18.5% used one or more TCAM modalities since being diagnosed with type 2 diabetes mellitus. The most frequently used TCAM was herbal medicine and the most commonly used herbs were Fenugreek (83.6%), Bitter gourd (83.6%), and Turmeric (76.7%). Approximately 61.1% perceived TCAM’s benefit in relieving pain and numbness in the hands, feet, and legs. The main source of information for TCAM use were friends/relatives (87.7%) followed by neighborhood friends (80.8%) and other diabetes patients (74.0%), however, only 44% of TCAM users discussed their use with their doctors. Ethnicity (OR = 3.664; 95% CI: 1.436-9.348, p < 0.01), family history of diabetes (OR = 2.313; 95% CI: 1.026-5.216, p < 0.05), patients not encountered challenges during hospital treatment (OR = 2.537; 95% CI: 1.201-5.362, p < 0.05), and patients who applied self-management practices during the COVID-19 pandemic (OR = 2.967; 95% CI: 1.387-6.349, p < 0.01) were strong predictors of TCAM usage. Conclusion: The prevalence of TCAM use among type 2 diabetes patients in Nepal was low (18.5%). Patients believed TCAM to be effective, obtained TCAM information from informal sources, and did not disclose their use to healthcare providers. The findings highlight the importance of health education programs on TCAM use and its additive and synergistic effects. It is also imperative for healthcare providers across Nepal to ask their patients about the self-use of TCAM during each consultation to avoid potential TCAM-antidiabetic drug interactions. TCAM should be considered for integration into national; health care system in a controlled manner in Nepal. Keywords: Complementary and alternative medicine; traditional medicine; herbal medicine; Type 2 diabetes mellitus; Corona virus disease 2019 (COVID-19), Nepal