Complementary and alternative medicine (CAM) is gaining popularity throughout the world, with an increase in the number of practitioners as well as the number of patients consulting them (BMJ, 1996). Population-based studies conducted in industrialized countries such as Australia, Scotland, UK, Taiwan, Singapore and the United States of America (USA), report that one-half to two-thirds of adults use CAM (Emslie et al., 1996, MacLennan et al., 2002, Lew-Ting 2003, Lim et al., 2005, Tindle et al., 2005). The growing incidence of chronic and incurable diseases has led to the increased use of CAM in recent years (Eisenberg et al., 1998; Dunning, 2003). Diabetes mellitus (DM) is one such chronic and incurable disease which is highly prevalent worldwide. It is one of the major burdens of diseases of the twenty first century (WHO-IDF, 2004). Worldwide, every ten seconds, at least one person dies from diabetes and its complications (Siegel & Narayan, 2008).
Conventional medicine for diabetes has been geared toward regulating blood glucose with a combination of dietary modification, insulin and/or oral agents, maintaining ideal body weight, exercising regularly and self-monitoring of blood sugar (WHO-IDF, 2004). Good glucose control can, however, be difficult for many people with diabetes, because these conventional treatment plans require change of behaviour and lifestyle (Dunning, 2003). Due to the chronic nature of the disease, the debilitation of complications, the threat of death and the complexities of treatment plans, people with diabetes often work proactively to manage their condition, optimize their health and try to alleviate complications through use of CAM (Dunning, 2003, Bell et al., 2006).
Homeopathy is one of the most popular CAM systems of treatment (BMJ, 1996). A recent observational study (Pomposelli et al., 2009) reported that “complementary homeopathic therapy of diabetic neuropathy was feasible and had promising effects in symptom scores and cost savings“; the study also concluded that “it is possible to treat patients with homeopathy, monitored by the conventional diabetes specialist, without any major problem of compatibility between the two forms of therapy“. However, while there is evidence in support of the use of homeopathy for the management of diabetes, it is important to know the prevalence and pattern of use of homeopathy among diabetic patients. This study aims to investigate the prevalence and correlates of use of homeopathy in diabetic patients.
This study is a comprehensive literature review of published studies in peer reviewed journals. In this review the research question is: What is known about prevalence and correlates of use of homeopathy in diabetic patients? To answer the research question the author searched the available studies with pre-requisite criteria. Then the author critically examines those studies, and finally summarizes the findings of the selected studies in a descriptive manner.
To achieve this aim, the research question has been broken down into the following objectives –
· To investigate the prevalence of use of homeopathy in diabetic patients
· To know the pattern of the use of homeopathy in diabetic patients
· To find out the correlates of use of homeopathy in diabetic patients
An extensive search was performed at the following electronic databases for published (in English language only) studies: AMED (Allied and Complementary Medicine), Ovid MEDLINE, EMBASE, PubMed; BioMed Central; EBSCOhost (Academic Search Complete & CINAHL Plus). Diabetes, homeopathy (& homoeopathy), prevalence, CAM, complementary medicine, alternative medicine and pattern of uses are the key words which were used to search the electronic database. References of the primarily obtained article were also screened for eligible studies. The inclusion and exclusion criteria applied in this study were as follows:
· Original (primary) research articles
· Studies published in peer-reviewed journal
· Studies with any design, reporting prevalence of use of homeopathy
· Studies other than survey were excluded
· Studies not in English Language
· Studies that reported combined use with other CAM, but where separate quantitative data of prevalence of use of homeopathy wasn’t available.
Data from all selected studies were extracted in a summary table under the following headings:
· Study type (survey method)
· Study site
· Study year
· Sample Size
· Sampling procedure
· Demography of the sample (age, gender, ethnicity, socioeconomic status and educational status)
· Prevalence of use of Homeopathy
· Factors associated with the use of homeopathy
Quality of the eligible studies was assessed according to the review article of Loney & Stratford (1999). Critical examination of the studies was carried out according to the guidelines of Loney et al (1998).
Literature search yielded fourteen studies. Five studies were excluded as they reported prevalence of overall CAM but homeopathy was not included (Egede, 2004; Schoenberg et al, 2004; Lind et al, 2006; Hasan et al, 2009 and Dunning, 2003). The study conducted by Garrow & Egede (2006a) was excluded as that did not report prevalence of homeopathy separately; this study reported acupuncture, Ayurveda, biofeedback, chelation, energy healing or Reiki therapy, hypnosis, massage, naturopathy, and homeopathy combined into an “other” group because very few respondents with diabetes used these treatments (as they proclaimed in their study). Another study (Garrow & Egede, 2006b) was excluded as it did not report prevalence of homeopathy, but reported association between complementary and alternative medicine use, preventive care practices and use of conventional medical services among adults with diabetes. The study conducted by PagÃ¡n & Tanguma, (2007) explored affordability and use of complementary and alternative medicine by adults with diabetes and that was excluded from the review as prevalence of use of homeopathy in diabetic patients was missing. Another study was excluded as it was a review (Chang et al, 2007) and not a primary study.
Lastly, five studies met the inclusion criteria; and were selected for final review. A close examination revealed that two papers (Mehrotra et al, 2004; Kumara et al, 2004) out of five selected reported the same data from a single study. Among these two papers the former one (Mehrotra et al, 2004) was included in this study because of its relevancy, while the latter (Kumara et al, 2004) was excluded to avoid duplication. Finally, four studies were included for this study. Identification details of the studies included in this review are given in table 1.
|Table 1 Studies included for analysis in this review|
|Running head||First author||Journal||Publication year|
|Prevalence of complementary medicine usage within||Leese G.P.||Practical Diabetes International||1997|
|Use of Complementary and Alternative Medicine||Yeh G.Y.||American Journal of Public Health||2002|
|Use of complementary and alternative||Mehrotra R.||The National Medical Journal of India||2004|
|Use of complementary and alternative medicine||Dannemann K.||Pediatric Diabetes||2008|
Three studies reported both prevalence of use of homeopathy and determinants of use in diabetic patients (Mehrotra et al, 2004; Dannemann et al, 2008). The last study (Yeh et al, 2002) reported only the prevalence of use of homeopathy among diabetic patients. Only one study was a nationally representative survey (Yeh et al, 2002), others were sporadic surveys. One survey was conducted in India, one in USA, one in UK and the other one in Germany.
Two studies included diabetic patients of all ages (reference), one study included only patients over eighteen (reference) and another study (reference) was conduct among diabetic children age range 1 to 18. Samples from every socio-economic status were included in all studies.
Prevalence of use of homeopathy among diabetic patients varied from 0.7% to 12.9%. Lowest prevalence (0.7%) was reported in USA and was a national representative telephone survey. On the other hand, highest (12.9%) usage was found at India. Another two studies from developed countries, United Kingdom and Germany, found the prevalence of use of homeopathy in diabetic patients 4.5% and 7.9% respectively. In Germany, homeopathy is the CAM system of treatment most used by diabetic patients.
None of the studies reported determinants of use of homeopathy specifically, but just of overall CAM. However, determinants of use of CAM such as high levels of education and the desire for early and maximum benefit, have been reported (Mehrotra et al, 2004). Geographical areas were also found significant in use of CAM, for example higher usage of CAM was found in West Germany compared with the East Germany (Dannemann et al, 2008). It has also been reported that patients who suffer from diabetes for a long time are more likely to perceive benefit from CAM, therefore those diabetic patient use and recommend CAM more than the patients who are suffering for a short time. Details of finding showed in table 2
|Table 2 Result|
|Study||Study Setting||Study site/year||Sample Size/procedure||Age of the Participants||use of Homeopathy||Co-related factors|
|Yeh et al, 2002 at USA||Telephone survey||Nationally representative / Nov ’97 and Feb ’98||2055 respondents|
|18+||0.7 %||Not reported|
|Leese et al, 1997 at UK||Questionnaire interviewed by a research nurse||Diabetic Clinic|
Study period not reported
|328 approached, 246 agreed to be interviewed./ Convenience sample||16 to 86|
|4.5%||Previous use of CAM|
Patient who had diabetes for long were more likely to perceive benefit from CAM
|Mehrotra et al, 2004 at India||Semi-structure interview||Outpatient endocrine clinic /1999-2001||493/systematic random sampling||All age|
Mean age 48.8 years[SD=12.6]
|12.9%||The desire for early and maximum|
Benefit, high levels of education (p=0.02)
|Dannemann et al, 2008 at Germany||self-completed survey||In four pediatric diabetes|
centers in Germany /
Nov ’04 to Dec ’05.
|1-18 yrs. mean|
11.9 3.8 yr
|7.9 %||Significant higher usage of CAM was found in West Germany compared with the East (25.0 vs. 14.0%, p , 0.05).|
One study (Dannemann et al, 2008) that explored use of CAM in children with type 1 diabetes, found the majority of CAM users were motivated by the wish to try everything and a conviction that CAM has less side effects, while their expectations were an improved well-being of the child and the prevention of microvascular and neurological complications. This study did not report whether these findings were statistically significant or not.