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Medical Pluralism and Diabetes

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Presentation at the 3rd International Conference on Medical Pluralism. Cavite State University 12 Mar 2019.

Published in: Health & Medicine
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Medical Pluralism and Diabetes

  1. 1. MEDICAL PLURALISM & DIABETES Iris Thiele Isip Tan MD, MSc Professor 3, UP College of Medicine Director, UP Manila Interactive Learning Center Chief, UP Medical Informatics Unit
  2. 2. WHY do persons with diabetes use complementary & alternative medicine (CAM)? WHAT are the safety concerns for CAM use in diabetes? HOW can patients evaluate online information on CAM?
  3. 3. Persons with diabetes are 1.6 times more likely to use CAM than those without diabetes. Garrow et al. Diabetes Care 2006;29:15-19
  4. 4. The chronicity of diabetes leaves those diagnosed feeling that they have lost control. Warren et al. Health 2012;17(4):323–339
  5. 5. Used one or more CAM modality to control chronic condition and regain control over their bodies. Warren et al. Health 2012;17(4):323–339
  6. 6. Warren et al. Health 2012;17(4):323–339 Greater autonomy in decision making and treatment-seeking behavior from CAM practitioners vs MDs
  7. 7. Maintain control by assuming greater personal responsibility for their health by “doing something extra” Warren et al. Health 2012;17(4):323–339
  8. 8. CAM users’ perspectives on needed health system improvements Lin et al. Health Expectations 2013;18:1451-62
  9. 9. Audit of Diabetes-Dependent Quality of Life (ADDQOL-19) 453 persons with diabetes CAM use 46.1% Candar et al. Complementary Therapies in Clinical Practice 2018;31:1-6
  10. 10. Herbal Medicine Cupping Mind & Body Practices Leech (Hirudotherapy) Religious & Spiritual Healing Spa (Balneotherapy) 0 25 50 75 100 Candar et al. Complementary Therapies in Clinical Practice 2018;31:1-6 DISTRIBUTION OF CAM PRACTICES USED %
  11. 11. Candar et al. Complementary Therapies in Clinical Practice 2018;31:1-6 Lower QOL for those who used CAM in the last 12 months MOST affected Physical capacities Freedom in eating Freedom in drinking
  12. 12. WHY do persons with diabetes use complementary & alternative medicine (CAM)? WHAT are the safety concerns for CAM use in diabetes? HOW can patients evaluate online information on CAM?
  13. 13. Alfian S et al. Ann Trop Med Public Health 2016;9(3):174-179 CAM users had decreased adherence to prescribed medications
  14. 14. For example, in YouTube videos, he claims that "insulin is very poison to the system" and that watermelon, zucchini and green beans are "natural insulin." https://edition.cnn.com/2019/02/27/health/herbalist-diabetes-death-sentencing/index.html
  15. 15. Herbal medicines are complex mixtures of bioactive entities with varying degrees of therapeutic effects. Kesavadev J et al. Adv Ther 2017;34:60-77
  16. 16. Kesavadev J et al. Adv Ther 2017;34:60-77 Herbs may alter the absorption, distribution, metabolism and/or excretion of conventional drugs.
  17. 17. Herbs may interact with the same target molecules: synergistic or antagonistic herb- drug interaction Kesavadev J et al. Adv Ther 2017;34:60-77
  18. 18. Kesavadev J et al. Adv Ther 2017;34:60-77 Lack of proper adherence to manufacturing, marketing & storage protocols can lead to deterioration of product quality.
  19. 19. CHINESE HERB NEPHROPATHY Stephania tetrandra in weight reduction pills was substituted with nephrotoxic Aristolochia fangchi Kesavadev J et al. Adv Ther 2017;34:60-77
  20. 20. Kesavadev J et al. Adv Ther 2017;34:60-77 Most patients consider herbal preparations to be ‘natural’ or ‘safe.’ Physicians are mostly unaware of CAM use by their patients.
  21. 21. 5.19. There is no clear evidence that dietary supplementation with vitamins, minerals (such as herbal supplements chromium and vitamin D), herbs, or spices (such as cinnamon or aloe vera) can improve outcomes in people with diabetes who do not have underlying deficiencies and they are not generally recommended for glycemic control.
  22. 22. WHY do persons with diabetes use complementary & alternative medicine (CAM)? WHAT are the safety concerns for CAM use in diabetes? HOW can patients evaluate online information on CAM?
  23. 23. DISCUSS WITH YOUR PHYSICIAN
  24. 24. WHO runs or created the site or app? Can you trust them? WHAT is the site or app promising or offering? WHEN was its information written or reviewed? WHERE does the information come from? WHY does the site or app exist? http://nccih.nih.gov/health/webresources
  25. 25. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142. UNPROVEN THERAPIES Tend to be developed/promoted in isolation from established scientific facilities/associations
  26. 26. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142. UNPROVEN THERAPIES Contain misapplication of data from scientific literature Provide exaggerated or unrealistic claims
  27. 27. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142. UNPROVEN THERAPIES Often have the potential to be financially profitable to those who have developed, promoted or endorsed them
  28. 28. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142. UNPROVEN THERAPIES Generally communicated outside regular channels of scientific and clinical communities Details of therapies often secretive
  29. 29. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142. UNPROVEN THERAPIES Their proponents discourage or refuse consultation with or review by reputable physicians or scientists
  30. 30. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142. UNPROVEN THERAPIES Developers/promoters often claim a medical/ scientific “conspiracy” against them
  31. 31. NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH http://nccih.nih.gov
  32. 32. NIH OFFICE OF DIETARY SUPPLEMENTS http://ods.od.nih.gov/
  33. 33. http://nccih.nih.gov/health/webresources Are you reading news or advertising?
  34. 34. Endorses a product. Only quotes people who say good things about the product. Presents research findings that seem too good to be true. Contains links to a sales site. Includes only positive reader comments. You can’t add a comment of your own. ADVERTISEMENT NOT NEWS nccih.nih.gov/health/webresources
  35. 35. Understand WHY persons with diabetes use complementary & alternative medicine (CAM). Inform persons with diabetes WHAT the safety concerns for CAM use are. HELP patients evaluate online information on CAM.
  36. 36. MEDICAL PLURALISM & DIABETES Iris Thiele Isip Tan MD, MSc @endocrine_witch

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