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© 2003 by the American Diabetes Association, Inc.
Letters: Observations |
The Use of Complementary and Alternative Medicine Therapies in Type 2 Diabetic Patients in Mexico
1 Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Especialidades, Mexico City, Mexico
2 Unidad de Investigación Médica en Bioquímica, Hospital de Especialidades, Mexico City, Mexico
3 Laboratorio de Plantas Medicinales, Hospital de Especialidades, Mexico City, Mexico
Address correspondence to Niels Wacher, Unidad de Investigacion Medica en Epidemiologia Clinica, Hospital de Especialidades. CMN SXXI IMSS, Cuauhtemoc, Col, Doctores, Mexico. E-mail: nwacher{at}hotmail.com
The growing utilization of complementary and alternative medicine (CAM) therapies represents one of the characteristic phenomena facing scientific medicine. Studies of the patient’s opinions and attitudes toward CAM therapies are scarce. Among doctors, it is widely considered that the use of CAM therapies is only linked to a particular social or cultural background. We undertook a cross-sectional study designed to evaluate the spontaneous use of CAM therapies among 573 type 2 diabetic patients (aged 51.9 ± 10 years) in nine family medicine clinics in Mexico City, using a questionnaire form.
Almost 62% (353) of participants make use of CAM therapies, a higher percentage than that reported in the U.S. (8%) and Canada (37.3%). Our patients were younger, more likely to be women, less educated, and were all members of the public insurance system. Sixty-four percent did not disclose this practice to their physician, while 57% of American diabetic patients discussed CAM therapies with their physicians. Among Mexicans, the decision to use CAM therapies proceeded mainly from the patient’s domestic environment (69%), while in only 8% of cases the treatment was recommended by physicians and nurses. Paradoxically, American diabetic subjects had CAM therapy recommended by their doctors and nurses in almost 43% of cases, a difference that reflects the general disregard of doctors who respect CAM therapies in Mexico, regardless of the local culture. Mexican patients who use CAM therapies prefer herbal remedies (332 [94.2%]), while the remaining 5.8% use other treatments. In Mexico the use of plants has a long historical tradition, while in the U.S. only 20% of diabetic subjects use herbal medicine (1). In Mexico, the cactus Opuntia is the favorite plant remedy among the majority of patients (73.1%) as a "traditional indigenous" treatment of type 2 diabetes. The Opuntia medicinal properties have already been scientifically evaluated and the hypoglycemic effect of its sap confirmed in clinical studies (2). Nevertheless, patients ignore the sum of effects that may occur during the simultaneous use of more than one hypoglycemic agent, or other potentially toxic effects (Medicago sativa, Taraxacum officinale, stigma of Zea mays, and Equistem robustum are considered diuretics; Clematis dioca, Tamarindus indica, Rhamnus purshiana, and Carica papaya are used as laxatives; and the leaves of Physalis, Phoradedron, and Calea are considered toxic but were used by 14 [4.2%] patients in this sample) (3).
This situation confirms that studies are required to determine the impact of CAM therapies, especially that of widespread popular herbal remedies, on diabetes management instead of ignoring the sociomedical phenomena taking place in our societies.
APPENDIX
The DIMSS Study Group: Margarita Jiménez, BSc,A José Halabe, MD, A Raúl Ariza, MD,B Héctor Fierro, MD,A Carlos Cuevas, MD,A Carlos Velasco, MD,B Moisés Mercado, MD,A Juan Garduño, MD, MSc,C Norma Juárez-Diaz, MD,A and Manuel de la Llata, MD,D; from UMF6: Anastasio Tapia, MD, and Elvira Rodriguez, MD; from UMF9: Luis Piñeiro, MD, Sandra Meléndez, MD, and Olivia Ruvalcaba, MD; from UMF11: Martin Gil Candelaria, MD, and Jesús Sánchez, MD; from UMF15: Laura Baillet, MD, and Antonio Gómez, MD; from UMF21: Martha Boijsseneau, MD, Bertha López-Castillejos, MD, and Maricela Garcia, MD; from UMF22: Mirella Gamiochipi, MSc; from UMF31: Patricia Vallejo, MD, and Mario Valencia, MD; from UMF34: Isabel Hernández, MD, Ida Báez-Toquiantzi, MD, and Rogelio Huerta, MD; and from UMF94: Ana Marin Cortés, MD, Rosa Ceja, MD, and Etelvina Zavala, MD.
AHospital de Especialidades Centro Médica Nacional Siglo XXI; BHospital de Especialidades Centro Médico "La Raza"; CCoordinación de Atención Médica, IMSS; DHospital de Cardiologia "Luis Méndez" Centro Médico Siglo XXI.
References
- Edge L, Ye X, Zheng D, Silverstein M: The prevalence and pattern of complimentary and alternative medicine use in individuals with diabetes. Diabetes Care 25:324–329, 2002
[Abstract/Free Full Text]
- Frati A, Xilotl Diaz N, Altamirano P, Ariza R, Lopez-Ledesma R: The effect of two sequential doses of Opuntia streptacantha upon glycemia. Arch Invest Med 22:333–336, 1991
- Gori M, Campbell R Natural products and diabetes treatment (Review Article). Diabetes Educ 24:201–202, 1998
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