Association between the Use of Alternative Medicine and Adherence to Treatment in Patients with Type 2 Diabetes

Research Article

J Fam Med. 2021; 8(3): 1247.

Association between the Use of Alternative Medicine and Adherence to Treatment in Patients with Type 2 Diabetes

Perez-Sosa Abigail M¹*, Gregorio PR² and Soto-Pena Sonia A¹

¹Department of Family Medicine, Family Medicine Unit #46 (IMSS), Mexico

²Department of Family Medicine, Family Medicine Unit #48 (IMSS), Mexico

*Corresponding author: Perez-Sosa Abigail Melissa, Department of Family Medicine, Family Medicine Unit #46 (IMSS), Chihuahua Delegation, Mexico

Received: March 02, 2021; Accepted: April 14, 2021; Published: April 21, 2021

Abstract

Background: Diabetes mellitus 2 (T2D) is the leading cause of morbidity and mortality in northern Mexico. Various treatments are used to control the disease; however, the cost of these and the difficulty of dietary management have as a consequence that the patient abandons them and looks for cheaper and easier-to-use alternatives.

Aim: The purpose of this study is to determine the relationship between the use of alternative medicine and adherence to medical treatment in patients with T2D.

Design and Setting: Analytic cross-sectional study.

Methods: An analytical cross-sectional study was designed between March and July 2019 including 464 patients with T2D from the family medicine unit #48 Ciudad Juarez, Mexico. We used the Morisky-Green scale for adherence to treatment and the use of Alternative Medicine (CAM) was evaluated with a holistic complementary and alternative medicine questionnaire. The Chi-Square test was used for comparison of proportions and risk factors were calculated using odds ratio with 95% confidence intervals.

Results: 53% of patients use CAM; biological therapy (herbs and supplements) is the most frequent (94%). The association between CAM use and adherence to medical treatment was 2.1 (95% CI 1.4-3.1, p= 0.001). The risk factors for the use of CAM were female sex, basic level education, uncontrolled disease and a time of evolution greater than 10 years.

Conclusion: CAM users are 2.1 times more at risk of having a regular or bad adherence to medical treatment.

Keywords: Alternative medicine; Adherence to treatment; Diabetes mellitus

Introduction

Diabetes is the leading cause of morbidity and mortality in northern Mexico [1]. Various treatments are used in its control, but their cost and the difficulty of dietary management cause the patient to seek other alternatives, which generates a poor adherence to medical treatment [2-3]. It is estimated that adherence to treatment in patients with T2D is around 60% [4]. The World Health Organization (WHO) identifies five causal factors for which patients do not adhere to treatment, among which are variables related to the patient, treatment, health system, disease, and the socioeconomic variables. Diabetes patients are 1.6 times more likely to use alternative medicine (CAM) than non-diabetic patients [6].

Adherence to treatment is defined as that behavior of the patient that coincides with the prescribed medical indication in relation to the form and times of administration of medications, diet and changes in lifestyle [7]. CAM is defined as a diverse care system, practices and products that are generally not considered part of conventional medicine [8]. CAM is subdivided into five categories: 1) biological therapies: herbs and dietary supplements; 2) alternative medical systems: acupuncture; 3) systems based on manipulation of the body: chiropractors; 4) mind body interventions: taichi or yoga and 5) energy therapies: reiki [9]. Due to the above, the main objective of this research was to determine the relationship between the use of alternative medicine and adherence to medical treatment in patients with T2D and to determine the sociodemographic characteristics of CAM users, the degree of adherence to medical treatment and glycemic control.

Material and Methods

Study design and population

A descriptive, cross-sectional, analytical study was designed at FMU 48 Ciudad Juarez, Mexico; between March and July 2019. Patients with T2D of legal age, both sex and who agreed to participate in the study were included; those that did not have recent paraclinical studies or incomplete information were eliminated. All included patients signed an informed consent letter.

Variables

The evaluation of adherence to treatment was with the Morisky- Green scale (8= High, 6-7= Medium and <6= Low) and the use of CAM was evaluated with a holistic questionnaire of complementary and alternative medicine (>33= Yes, <33= No), the scales were answered by the participants.

Statistical analysis

Measures of central tendency and percentages were used for the sociodemographic variables. Also, the Chi-Square test for comparison of proportions; risk factors were calculated using odds ratios and their 95% confidence intervals.

Ethics

This study was authorized by the Local Health Committee (CLIES 802) with registration number R-2019-802-021. The research was carried out in accordance with the Regulations of the General Health Law on Research for Health, the Declaration of Helsinki and the Bioethical Principles.

Results

488 patients were recruited, of which 24 were eliminated, 22 for not having recent paraclinical tests and 2 for complete information. A total of 464 patients were studied whose sociodemographic characteristics were: mean age 58.5 years (range 26-96), female sex 64.7%, industry operator occupation 28%, marital status married 73.9% and primary education 50.2% (Table 1). In relation to T2D, the most frequent evolution time was less than 5 years with 33.2%. The most frequently associated comorbidity was systemic arterial hypertension (51.7%) and uncontrolled blood glucose in 53.4% of the cases. Regarding adherence to medical treatment, it was found that only 39% of the participants had good adherence to treatment, 61% fair or poor. Of the total number of patients, 52.6% admitted the use of CAM, biological therapy was used more frequently (94%). The odds ratio was calculated to evaluate the association between the use of CAM and adherence to medical treatment, obtaining a value of 2.1 (95% CI 1.4-3.1, p= 0.001) (Table 2). The risk factors for the use of CAM were also analyzed, among which the basic level schooling with OR= 1.6 (95% CI 1.0-2.6, p= 0.036), uncontrolled blood glucose OR= 1.6 (95% CI 1.1-2.4, p= 0.007), female gender OR= 1.7 (95% CI 1.2-2.6, p= 0.003) and evolution of the disease over 10 years OR= 2.6 (95% CI 1.7-3.8, p= 0.001) (Table 3).