Prevalence, traditional medicine use and co-morbidities among type 2 diabetes mellitus in outpatients - a cross sectional hospital-based survey in KwaZulu-Natal

Abstract

Throughout the world, diabetes mellitus (DM) affects people of all ages, irrespective of gender and ethnicity, and impacts both rural and urban areas, as well as developing and developed countries. The prevalence of DM in sub-Saharan Africa is a significant public health burden which is attributed to inadequate health care funding, limited medicinal access and the disproportionate provision of resources between private and public health care. Approximately 451 million adults worldwide have diabetes, with predictions of 693 million cases by 2045. Moreover, Type II diabetes mellitus (T2DM) accounts for approximately 90% of diabetics, making it the most common type. Premature morbidity and mortality are associated with it, leading to micro- and macrovascular complications. There is a growing trend for patients to use traditional medicine (TM) commonly known as complementary and alternative medicine in most countries, in an attempt to eliminate or minimize the consequences of their illnesses and improve their general health. Therefore, this study aimed to determine the prevalence and, extent of traditional medicine use and co-morbidities among T2DM in a regional hospital in KwaZulu-Natal. This was a quantitative and cross-sectional study made up of 2 phases. Phase 1 was based on a retrospective chart review of all outpatients who were treated for T2DM between August 2018- January 2019. Demographic data and existing comorbidities were obtained from the hospital registers. Phase 2 involved the prospective recruitment of participants using a structured questionnaire, to determine their use of home remedies/ traditional medicine for T2DM and their co-morbidities thereof. Data from phase 1 revealed significantly more female patients (3072) compared to male patients (1050) (p<0.001). Majority of the outpatients (77.42%) presenting with T2DM over the 6-month period were between the ages of 45 years and 74 years. There was a significant correlation between Indian female patients who presented with T2DM compared with African female patients (p<0.05). The more frequent comorbidities experienced by patients were hypertension (3212) and cardiovascular problems (460) with a prevalence of 77.9% and 11.16%, respectively. The likelihood of presenting with comorbidities increased significantly with age. Logistic regression test found that female patients with T2DM were at significantly higher risk of presenting with hypertension (odds ratio [OR] = 1.44, 95% CI:1.20;1.71), arthritis (OR = 2.20, 95% CI:1.51;3.20) and anaemia (OR = 2.42, 95% CI:1.40;4.19), whilst their risk for cardiovascular problems was significantly lower compared to male patients (OR = 0.67, 95% CI: 0.54;0.83). The results obtained in phase 2 indicated that out of a total of 340 participants (n=244) included, 72% of them were female. T2DM was most prevalent in those aged 45 to 59 (47.94%). Out of 340 participants, only 92 (27%) used TM most often, with Indians (58.24%) being the most frequent users. Nearly 78 % of patients (n = 101) were using TM in conjunction with hospital medication. Families and friends were the most common sources of TM knowledge. Lemon and honey, Aloe vera, bitter gourd or karela, green tea, cinnamon, curry leaves and tulsi leaves were reported as the most commonly used TM. Traditional medicine use was predicted by various factors, including gender, race, age, education, residence, and presence of DM, however, no significant predictors for TM usage was noted among the variables tested. Traditional medicine use among African participants was 0.56 times (OR=0.56, 95% CI=0.34, 0.93), lower than that of Indian participants. Demographic factors, such as gender, ethnicity, and age, influenced the prevalence of T2DM and comorbidities. To allocate medical resources effectively and according to the true burden of disease from complications caused by T2DM, flexible and adaptive approaches are needed for prevention and management of T2DM cases. Furthermore, the study highlighted a low prevalence rate of TM usage (27.06%) in T2DM patients. Traditional medicine was predominately used among females and ethnicity was found to be a significant predictor of TM usage. The data from this study can be used to develop a tracking system, which will inform the health care systems with current information and may reduce the exponential rise of the number of patients suffering from DM. Future research is needed to determine if herbal therapies are effective therapeutic options in managing T2DM due to their safety and multiple targeting effects. Traditional medicine/ home remedies may be more effective in the development of anti-diabetic drugs if systematic data regarding their structure, activity, and mode of action is collected.