CHAPTER 1

Introduction

Background of the Study

Western Society tends to think of healing in terms of medical, surgical and other
technological interventions. However, in many other cultures both past and present,
healing has been promoted by faith, magic, ritual and other nonmedical approaches.
The use of alternative therapies and complementary therapies is becoming more
prevalent among the general public. Nurses are encouraged to think critically before
recommending or implementing these approaches and to also be open to the possibilities
that are available to help people live to their full potential.
According to Hippocrates The natural healing force within each one of us is the
greatest force in getting well. In this era of consumer-driven health care, individuals
with diabetes are turning to alternatives as in Hippocrates natural healing force, often
to seek lower-cost alternatives to traditional health care and eliminate certain medical
expenses.
Diabetes encompasses a group of diseases. Type 2 diabetes accounts for 90 to 95
percent of all diagnosed cases and occurs more frequently in older people. Type 1
diabetes, which accounts for 5 to 10 percent of cases, usually strikes children and young
adults. A third form, gestational diabetes, develops in some women during pregnancy.
Type 2 diabetes, most often is associated with older age (although it is increasingly being
diagnosed in children), obesity (about 80 percent of people with type 2 diabetes are

overweight), a family history of diabetes, and physical inactivity. Certain minority

population groups are at greater risk, as are women who have had gestational diabetes.
Type 2 diabetes usually begins as insulin resistance, a disorder in which cells do not use
insulin properly. Symptoms develop gradually and may include fatigue, frequent
urination, excessive thirst and hunger, weight loss, blurred vision, and slow-healing
wounds or sores. However, it is possible to have type 2 diabetes without experiencing
any symptoms (Halat, 2003).
People with diabetes should try to keep their blood glucose in a healthy range.
The basic tools for managing type 2 diabetes are healthy eating, physical activity, and
blood glucose monitoring. Many people also need to take prescription pills, insulin,
or both. Some people with diabetes use Complementary Alternative Medicine therapies
for their health condition. For example, they may try acupuncture or biofeedback to help
with painful symptoms. Some use dietary supplements in efforts to improve their blood
glucose control, manage symptoms, and lessen the risk of developing serious
complications such as heart problems (National Institute of Diabetes and Digestive and
Kidney Diseases, 2008).
Parents often use herbal medicine for their children because they believe it is
more natural and therefore safer. Indeed, very few adverse effects are reported in the
literature for Complementary Alternative Medicine use in diabetes (Yeh et al, 2003).
Global estimates of the prevalence of diabetes for 2010 is around 6.4%, affecting
285 million adults, and will increase to 7.7% and 439 million adults by 2030. Much of
this increase in diabetes will occur in Asia, such as India and China. With Taiwan being
part of the Asia Pacific region, the prevalence of diabetes is high at around 4.5%; this

disease is, in fact, emerging as a major health issue in Taiwan. The presence of such a
chronic, debilitating, and possibly painful illness has been identified as a reason why
patients seek out Complementary Alternative Medicine. In addition, Chang et al.
highlighted that the prevalence of Complementary Alternative Medicine use among
diabetic populations worldwide varies widely, depending on the definition of
Complementary Alternative Medicine and the survey design used by researchers. The
prevalence ranged from 17% in a UK study to 72.8% in the USA with an average of
45.5% of participants in the studies reporting the use of some form of Complementary
Alternative Medicine. Although evidence is mounting in support of the use of various
Complementary Alternative Medicine to treat a wide variety of complications of diabetes
mellitus, whether patients with Type 2 diabetes actually use Complementary Alternative
Medicines with known benefits in the management of diabetes is largely unknown.
Especially, the patterns of Complementary Alternative Medicine use among the Type 2
diabetes population are largely unknown, and no relevant study has been conducted
among patients with Type 2 diabetes in Taiwan. (Yeh et al, 2003).
Advances in the management of diabetes mellitus in the form of new drugs, new
sources of insulin and new approaches to practices are recommended for physicians.
However, the growing utilization of complementary and alternative medicine
(Complementary Alternative Medicine) represents one of the characteristic
phenomenons facing scientific medicine. Public interest in the use of Complementary
Alternative Medicine is on the rise. The use of Complementary Alternative Medicine in
the management of chronic disease is well known in developed countries and is practiced
to some extent in industrialized countries. Diabetic patients are more likely to use

Complementary Alternative Medicine because of the chronic course of the disease. A

large number of Complementary Alternative Medicine treatments have been
recommended for diabetes. Various degrees of hypoglycemic effects have been attributed
to most of these agents. However, the efficacy of most Complementary Alternative
Medicine therapy for glucose control and diabetes management is unproven. In general;
the scientific literature on the efficacy of Complementary Alternative Medicine in the
treatment of diabetes is relatively sparse and diverse (Alzahrani, 2010).
Research into the reasons for Complementary Alternative Medicine use by people
with diabetes is also limited. Some researchers have identified the growth of
Complementary Alternative Medicine use in other patient populations as being associated
with the perceived limitations of the medical paradigm and the apparent failure of
conventional medicine to treat and/or cure chronic illness and catastrophic diseases.
However, Coulter and Willis suggest that the growth in Complementary Alternative
Medicine use may be related to general societal changes. As social change and
globalization accelerate, faith in the ability of medical science to solve the problems of
human diseases has declined. This change within society might be interpreted as part of
the ascendancy of patient self-empowerment. This view suggests that patients seek out
Complementary Alternative Medicine because they believe it offers them more personal
autonomy and control over their healthcare decisions. However, several researchers have
found there are more complex reasons associated with philosophical congruence related
to Complementary Alternative Medicine use such as patients values, worldviews,
spiritual/religious philosophies, beliefs, or culture in relation to the nature and meaning of
health and illness. Thus, understanding the reasons for patients Complementary

Alternative Medicine use is important as it will help healthcare professionals to

understand the factors that underpin patients beliefs and attitudes towards their health
care. This is the case for any patient population including people with Type 2 diabetes
(Tiralongo et al, 2011).
The majority of patients use Complementary Alternative Medicine in conjunction
with conventional medicine, not as an alternative. Some studies investigated the issue of
communication of Complementary Alternative Medicine use with conventional
healthcare professionals, only some referred to diabetic patients. Egede and his
colleagues found fewer than 40% of Americans with diabetes who used Complementary
Alternative Medicine disclosed this information to their physicians. Little is known about
the disclosure rates among Taiwanese diabetes patients and a recent study showed that
35.4% had discussed Complementary Alternative Medicine use with their psychiatrists.
However, the literature offers little discussion of the reasons for this limited disclosure of
Complementary Alternative Medicine use and the apparent communication gap between
patients and healthcare professionals. This lack of discussion may indicate a deficiency in
the relationship between patient and healthcare professional which could have negatively
impact on patient care and health outcomes. In addition, most previous studies of
Complementary Alternative Medicine use among people with diabetes have used data
derived from either a medical expenditure survey or from health insurance claims in the
USA. Thus, these studies mainly focused on Complementary Alternative Medicine users
characteristics, but have not explained patients attitudes, motivations, and knowledge
about Complementary Alternative Medicine use. Research into the extent of
Complementary Alternative Medicine use, why and how it is used, and disclosure of use

to healthcare professionals is vital as results could help to improve communication

between healthcare professionals and patients and assist in planning better selfmanagement strategies for patients (Tiralongo et al, 2011).
Many of the rural older adults with diabetes included specific types and categories
of CAM therapies in their health self-management. These therapies were largely limited
to home remedies, vitamins, and minerals. Few (less than one in ten) of these rural older
adults used herbs, popular manufactured products, CAM therapies, or CAM practitioners.
Far more used CAM therapies for general use than they did for treating diabetes (Arcury,
2002).
Several Complementary Alternative Medicine treatments have been used for diabetes,
but the ones with the best evidence behind them are: 1. Traditional Chinese medicine
(TCM)this can include acupuncture, herbs, or bodywork to stimulate the bodys energy
(chi) and lower blood glucose. Dozens of studies of TCM (mostly the use of herbs)
showing benefit for diabetes have been published in China, but most Western docs arent
aware of them. 2. Herbal medicinesin addition to Chinese herbal medicine, six or more
Western and Ayurvedic (Indian) herbs have shown benefits in various studies. Other
Complementary Alternative Medicine treatments may not lower blood glucose, but may
help with symptoms and complications of diabetes. One is the hyperbaric oxygen therapy
(HBOT) which helps wounds heal. HBOT has greatly reduced the rate of foot
amputations in several studies, yet its rarely used. Another is Aromatherapy (sometimes
called essential oils therapy or flower essence therapy) can help reduce stress symptoms
and improve sleep. Chiropractic and massage therapies can help reduce pain and improve
mobility (Spero, 2008).

With all these, people, especially those with lifestyle diseases such as Type 2 Diabetes
still tend to look for other options to manage their health without making difficult
lifestyle changes despite many alternatives (cheaper medicines; nutrition and diet
management; exercise; and alternative practices). These had led the researchers to pursue
such study.

Objectives of the Study

This study aims to determine the perception and level of use of complementary
alternative medicine among selected Type 2 diabetics in Iloilo City.
Specific objectives:
Specifically, this study will seek answers to the following questions:
1. What is the profile of the type 2 diabetics when grouped according to age, sex,
educational attainment, marital status, occupation and monthly family income?
2. What is the perception on complementary alternative medicine of type 2 diabetics in
Iloilo City?
3. What is the level of use of complementary alternative medicine among type 2
diabetics in Iloilo City?
4. Is there a significant difference in the perception of the type 2 diabetics on CAM
when grouped according to age, sex, educational attainment, marital status,
occupation and monthly family income?

5. Is there a significant difference in the level of use of CAM among type 2 diabetics
when grouped according to age, sex, educational attainment, marital status,
occupation and monthly family income?
6. Is there a significant relationship between the perception and level of use of CAM
among type 2 diabetics in Iloilo City?

Theoretical Framework

This study will be anchored to the Theory of Reasoned Action by Martin Fishbein
and Icek Ajzen (1980). The key application of the theory of reasoned action is prediction
of behavioral intentions, spanning predictions of attitude and predictions of behavior. The
subsequent separation of behavioral intention from behavior allows for explanation of
limiting factors on attitudinal influence. The major components are the following links
between beliefs, attitudes, norms, intentions, and behavior of individuals.
The persons behavior is determined by ones intention to perform it. This
intention is determined by his attitudes and subjective norms towards the behavior.
Subjective norm is determined by ones beliefs on the consequences of the behavior
multiplied by ones evaluation of those consequences. Beliefs are the persons subjective
probability of performing a particular behavior which will produce specific results.
Relating these components to the study, it is presumed that type 2 diabetics
perception on Complementary Alternative Medicines is closely linked and determined by
their beliefs, subjective norms and intentions. Their perceptions, being determined by
these vary and are basically influenced as they age, by their marital status, occupation and

the income they earn. While their level of use of Complementary Alternative Medicine
are based on their attitude towards it which in turn led them to perform such behavior, the
behavior of choosing the type or kind of Complementary Alternative Medicine that they
intend to use, how often, how religiously been taking it, and the length of time they have
been using such alternatives.

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Conceptual Framework

The research paradigm shows the flow of relationship among the variables. The
type 2 diabetics will be categorized according to age, sex, educational attainment, marital
status, occupation and monthly family income as the antecedent variables. The
Independent and dependent variables will be the Perception on and the level of use of
Complementary Alternative Medicine respectively.
Antecedent
Variable

Independent
Variable

Profile

Perception
On
CAM

Age
Sex
Educational Attainment
Marital Status
Occupation
Family Monthly Income

Dependent
Variable
Level of Use
of
CAM

Figure 1. Research paradigm showing the assumed relationship between the dependent
variable, independent variable and antecedent variables.

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Hypotheses of the Study

Based on the identified problems, the following hypotheses will be set forth:
1. There is no significant difference in the perception of the type 2 diabetics on
Complementary Alternative Medicine when grouped according to age, sex,
educational attainment, marital status, occupation and monthly family income.
2. There is no significant difference in the level of use of CAM among type 2 diabetics
when grouped according to age, sex, educational attainment, marital status,
occupation and monthly family income.
3. There is no significant relationship between the perception and level of use of CAM
among type 2 diabetics in Iloilo City.

Definition of Variables and Other Terms

For clarity and precision, the following terms were defined conceptually and
operationally.
Perception refers to an impression, an attitude or understanding based on what is
observed or thought. This can be a general awareness or possession of information, facts,
ideas, truths, or principles (Microsoft Encarta, 2009).

In this study, perception refers to the possessed information diabetics have on the
different types and uses of complementary alternative medicine. This will be categorized
as Good, Fair, and Poor perception.

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Level of Use refers to a rank or scale in employing something into action or service for
some purpose (Microsoft Encarta, 2009).
In this study, Level of Use of Complementary Alternative Medicine refers to the
scale of CAM use among diabetics. This will be categorized as High and Low use.

Complementary Alternative Medicine refers to a group of diverse medical and health

care systems, practices, and products that are not generally considered to be part of
conventional medicine (National Center for Complementary and Alternative Medicine,
2002).
In this study, it refers to the most common form of or groups of CAM specifically
used by type 2 diabetics. It will be categorized into supplements, herbals, and therapies.

Other Terms:
Age the period of time during which someone or something has lived or existed
(Webster Dictionary, 2010).
In this study, age refers to the corresponding age of the respondents. It is
categorized as young adult for age 20-39 years old; middle adult for age 40-59; and late
adult for age 60 and above.
Sex the characteristics that distinguish male and female organism on the basis of their
reproductive formation (Webster Dictionary, 2005).
In this study, it refers to the characteristics of the respondents as to being male or
female.

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Type 2 Diabetes a disease in which the pancreas fails to secrete adequate levels of
insulin to accommodate blood glucose level (Delaune, 2006).
In this study, this refers to the condition experienced by the respondents.
Educational Attainment this refers to the highest grade completed within the most
advanced level attained in the educational system of the country where such education
was received (Organization for Economic Cooperation and Development, 2011).
In this study, this refers to what degree or level of education the respondents
attained and categorized as Post graduate; College; High School; Elementary; and Not
Educated.
Marital Status relating to marriage or the married state (Webster Dictionary, 2005).
In this study, this refers to the marital state of the respondents and categorized as
Single; Married; and Widow/widower.
Monthly Family Income the amount of money received over a period of time either as
payment for work, goods, or services, or as profit on capital (Groiler Encyclopedia,
2005).
In this study, it refers to the amount of money earned by the respondents per
month as categorized as High for income P6, 683 and above and Low for income P6,
683 and below.
Occupation the labor, task or duty that is ones accustomed means of livelihood
(Webster Dictionary, 2005).
In this study, it refers to the work of the respondents in which they are earning
their monthly income. It is categorized as having a White Collar Job for those working
in the office, such as administration officers, businessmen, call center agents, customer

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service representatives, and other professionals. Blue Collar Job for those having
manual work/labor such as mason, construction workers, vendors, sales ladies, factory
workers and the like. None for those who are not working or unemployed.

Significance of the Study

The results of this study will be viewed to be of benefit to the following:
Diabetics
The result of the study will serve as a basis in educating diabetics and motivating
them to properly comply with the therapeutic treatment, likewise be aware of the proper
use of different types of Complementary Alternative Medicine and its therapeutic effects.
Their perception on and level of use of CAM can be a breakthrough leading to more
research on its effects; affordability and accessibility.

Family Members
The findings of this study will help family members deal with the member who
opted to use CAM. It helps them understand how to provide care and enhance and
improve their well being and life. It can further strengthen the diabetics family support as
well as their awareness on how to deal with Diabetes in the light of different helpful
alternatives.

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Department of Health
This study will benefit the DOH, for they may be able to evaluate the extent of
usage of CAM among the population. The result of this study will also help them identify
areas for further research such as specific to a particular type/kind of CAMs potency
and be able to formulate and organize programs and services in relation to CAM. The
department with its pool of health professionals can advocate the use of different
effective and safe CAMs.

Future Researchers
This study will serve as a baseline data and future reference study regarding
CAM. This can also serve as a tool for future interventions and programs in which future
researchers can use and share. Results of this study will help future researchers to
continually discover specific

Scope and Limitations of the Study

This study will utilize a descriptive - correlational research utilizing one-shot
survey design and will be limited to determine the perception and level of use of CAM
among selected type 2 diabetics in Iloilo City.
This will be participated by 50 diabetics who were diagnosed of diabetes and had
been considering to use or have been using a kind of CAM in the course of their
treatment or management of diabetes.

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The researchers will be using a researchers made instrument in gathering data

and it will be validated by panel of experts on diabetes and CAM.
Frequency distribution, percentage, and mean will be used for descriptive analysis
of data. Chi-square will be utilized to determine the significance of the difference in the
antecedent, dependent, and dependent variable in the study. T-test and Pearson r will be
used to determine the significance in the relationship between the independent and
dependent variables. The level of significance will be set at 0.05.

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CHAPTER 2
Review of Related Literature

Diabetes Mellitus
Diabetes encompasses a group of diseases. Type 2 diabetes accounts for 90 to 95
percent of all diagnosed cases and occurs more frequently in older people. Type 1
diabetes, which accounts for 5 to 10 percent of cases, usually strikes children and young
adults. A third form, gestational diabetes, develops in some women during pregnancy.
In all forms of diabetes, the bodys ability to convert food into energy is impaired.
After a meal, the body breaks down most food into glucose (a kind of sugar), the main
source of fuel for cells. In people with diabetes, the body does not make enough insulin
a hormone that helps glucose enters cellsor the cells do not respond to insulin properly.
Often, both insulin production and insulin action are impaired. Without treatment,
glucose builds up in the blood instead of moving into the cells, where it can be converted
into energy. Over time, the high blood glucose levels caused by diabetes can damage
many parts of the body, including the heart and blood vessels, eyes, kidneys, nerves, feet,
and skin. Such complications can be prevented or delayed by controlling blood glucose,
blood pressure, and cholesterol levels. (National Diabetes Information Center, 2007)
Type 2 diabetes, most often is associated with older age (although it is
increasingly being diagnosed in children), obesity (about 80 percent of people with type 2

18

diabetes are overweight), a family history of diabetes, and physical inactivity. Certain
minority population groups are at greater risk, as are women who have had gestational
diabetes. Type 2 diabetes usually begins as insulin resistance, a disorder in which cells do
not use insulin properly. Symptoms develop gradually and may include fatigue, frequent
urination, excessive thirst and hunger, weight loss, blurred vision, and slow-healing
wounds or sores. However, it is possible to have type 2 diabetes without experiencing
any symptoms (Arcury, 2006).
The name of this set of symptoms comes from the Greek; diabetes means "passing
through" and mellitus means "honey." In other words, "honey passing through," or high
levels of sugar in the urine, was what the ancient doctors first observed. The disease is
characterized by high levels of sugar in the blood, which "spills over" into the urine, and
is almost universally related to chronically high intake of simple carbohydrates in the
diet. With 4% of the population medically diagnosed with Diabetes Mellitus, it has
become the 7th leading cause of death in the U.S. and the incidence is rising.
The good news is that 90% of non-insulin dependent diabetics will be cured by
achieving their optimal weight and eating a balanced diet. Other theoretical causes for the
deficiency of insulin include viral infection of the insulin-producing beta cells of the
pancreas, toxic reaction to N-nitroso compounds (found in smoked and cured meats), and
auto-immune disease. The great dangers of uncontrolled diabetes include premature heart
disease, stroke, atherosclerosis, and eventually gangrene of the lower limbs, blindness
and pancreatic failure. There is a significant familial component to this disease.
Because diet is so critical to the control of this disease, nutritional approaches will be
discussed first. However, there are lots of other ways to control DM (Diabetes Mellitus),

19

including Botanical Medicine with its array of insulin-like plants, Homeopathy,

Traditional Chinese Medicine (TCM) and psychological approaches.

People with diabetes should try to keep their blood glucose in a healthy range. The basic
tools for managing type 2 diabetes are healthy eating, physical activity, and blood glucose
monitoring. Many people also need to take prescription pills, insulin, or both.

Complementary Alternative Medicine

The National Center for Complementary and Alternative Medicine (NCCAM), a
part of the National Institutes of Health, defines CAM as a group of medical and healthcare systems, practices and products that are not presently considered to be part of
conventional medicine. Conventional medicine, on the contrary, is medicine as practiced
by holders of MD (medical doctor) or DO (doctor of osteopathy) degrees and by tallied
health professionals, such as physical therapists, psychologists and registered nurses.
However, it should be noted that some healthcare providers practice both CAM and
conventional medicine (National Center for Complementary and Alternative Medicine,
2007)
Traditional medicine, or complementary and/or alternative medicine (CAM)
refers to health practices, approaches, knowledge and beliefs incorporating plant, animal
and mineral based medicines, spiritual therapies, manual techniques and exercises,
applied singularly or in combination to treat, diagnose and prevent illnesses or maintain
well-being. CAM has maintained its popularity in all regions of the developing world
and its use is rapidly spreading in industrialized countries. For instance, in Africa, 80% of

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the population uses traditional medicine to help meet their health care needs. In Europe,
North America and other industrialized regions, over 50% of the population have used
CAM at least once in their lives.

Supplements
Supplements used for diabetes, with a focus on some that have been studied in
clinical trials, such as alpha-lipoic acid, chromium, omega-3 fatty acids Essential
nutrients that the body cannot make on its own but can obtain from foods such as fish and
flaxseed, or from dietary supplements., and polyphenols (Halat, 2003).
Alpha-lipoic acid (ALA, also known as lipoic acid or thioctic acid) is an antioxidant
a substance that protects against cell damage. ALA is found in certain foods, such as
liver, spinach, broccoli, and potatoes. Some people with type 2 diabetes take ALA
supplements in the hope of lowering blood glucose levels by improving the bodys ability
to use insulin; others use ALA to prevent or treat diabetic neuropathy (a nerve disorder).
Supplements are marketed as tablets or capsules. ALA has been researched for its effect
on insulin sensitivity, glucose metabolism, and diabetic neuropathy. Some studies have
found benefits, but more research is needed. (There are some studies, reported from
outside the United States, of ALA delivered intravenously; however, this research is
outside the scope of this fact sheet.) Because ALA might lower blood sugar too much,
people with diabetes who take it must monitor their blood sugar levels very carefully
(Halat, 2003).
Chromium is an essential trace mineralthat is, the body requires small amounts of it
to function properly. Some people with diabetes take chromium in an effort to improve

21

their blood glucose control. Chromium is found in many foods, but usually only in small
amounts; relatively good sources include meat, whole grain products, and some fruits,
vegetables, and spices. In supplement form (capsules and tablets), it is sold as chromium
picolinate, chromium chloride, and chromium nicotinate. Chromium supplementation has
been researched for its effect on glucose control in people with diabetes. Study results
have been mixed. Some researchers have found benefits, but many of the studies have not
been well designed. Additional, high-quality research is needed. At low doses, short-term
use of chromium appears to be safe for most adults. However, people with diabetes
should be aware that chromium might cause blood sugar levels to go too low. High doses
can cause serious side effects, including kidney problemsan issue of special concern to
people with diabetes (Althuis, 2002).
Omega-3 fatty acids are polyunsaturated fatty acids that come from foods such as
fish, fish oil, vegetable oil (primarily canola and soybean), walnuts, and wheat germ.
Omega-3 supplements are available as capsules or oils (such as fish oil). Omega-3s are
important in a number of bodily functions, including the movement of calcium and other
substances in and out of cells, the relaxation and contraction of muscles, blood clotting,
digestion, fertility, cell division, and growth. In addition, omega-3s are thought to protect
against heart disease, reduce inflammation, and lower triglyceride levels.Omega-3 fatty
acids have been researched for their effect on controlling glucose and reducing heart
disease risk in people with type 2 diabetes. Studies show that omega-3 fatty acids lower
triglycerides, but do not affect blood glucose control, total cholesterol, or HDL (good)
cholesterol in people with diabetes. In some studies, omega-3 fatty acids also raised LDL
(bad) cholesterol. Additional research, particularly long-term studies that look

22

specifically at heart disease in people with diabetes, is needed. Omega-3s appear to be

safe for most adults at low-to-moderate doses. Safety questions have been raised about
fish oil supplements, because some species of fish can be contaminated by substances
such as mercury, pesticides, or PCBs. In high doses, fish oil can interact with certain
medications, including blood thinners and drugs used for high blood pressure (Hartweg,
2007).
Polyphenols antioxidants found in tea and dark chocolate, among other dietary
sourcesare being studied for possible effects on vascular health (including blood
pressure) and on the bodys ability to use insulin. Laboratory studies suggest that EGCG,
a polyphenol found in green tea, may protect against cardiovascular disease and have a
beneficial effect on insulin activity and glucose control. However, a few small clinical
trials studying EGCG and green tea in people with diabetes have not shown such effects.
No adverse effects of EGCG or green tea were discussed in these studies. Green tea is
safe for most adults when used in moderate amounts. However, green tea contains
caffeine, which can cause, in some people, insomnia, anxiety, or irritability, among other
effects. Green tea also has small amounts of vitamin K, which can make anticoagulant
drugs, such as warfarin, less effective (Collins, 2007).
Other supplements are also being studied for diabetes-related effects. For example:
Preliminary research has explored the use of garlic for lowering blood glucose levels, but
findings have not been consistent. Studies of the effects of magnesium supplementation
on blood glucose control have had mixed results, although researchers have found that
eating a diet high in magnesium may lower the risk of diabetes. There is not enough
evidence to evaluate the effectiveness of coenzyme Q10 supplementation as a CAM

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therapy for diabetes; studies of its ability to affect glucose control have had
conflicting findings. Researchers are studying whether the herb. A plant or part of a plant
used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves,
bark, fruit, seeds, stems, and roots. Ginseng and the trace mineral vanadium might help
control glucose levels. Some people with diabetes may also try botanicals such as prickly
pear cactus, gurmar, Coccinia indica, aloe vera, fenugreek, and bitter melon to control
their glucose levels. However, there is limited research on the effectiveness of these
botanicals for diabetes (Halat, 2003).

Herbals

Most users of herbal remedies believed that this healthcare modality was an
important and effective mode for health and wellness promotion and disease
management, similar to a recent US study. We also observed that most users believed that
herbal remedies were either equally or more efficacious than conventional medicines, and
in fact about half of the sample suggested that herbs were more efficacious than
conventional medicines. Our findings, coupled with the high prevalence of herbal remedy
use in Trinidad, demonstrated the overwhelming endorsement of this healthcare modality
by patients accessing primary health care services on the island. Our results corroborated
well with a recent survey conducted by Tindle and his colleagues where a significant
number of CAM users perceived that these therapies had greater efficacy than
conventional allopathic medicines. In their study most respondents used conventional and

24

CAM modalities concomitantly and rated the perceived efficacy of the combined use as
greater than the individual modalities (Clement et al, 2007).

In the same study conducted by Clement et al in 2007, 265 herbal users entered
the study and cited over 100 herbs for the promotion of health/wellness and the
management of specific health concerns. Garlic was the most popular herb (in 48.3% of
the sample) and was used for the common cold, cough, fever, as 'blood cleansers' and
carminatives. It was also used in 20% of hypertension patients. 230 users (86.8%)
indicated that herbs were efficacious and perceived that they had equal or greater efficacy
than conventional allopathic medicines. Gender, ethnicity, income and years of formal
education did not influence patients' perception of herb efficacy; however, age did (p =
0.036). Concomitant use of herbs and allopathic medicines was relatively high at 30%;
and most users did not inform their attending physician.

Therapies

As in the cases of other diseases, naturopathy recommends a diet and no drugs.

The main purpose is to help the body to assimilate the sugar into the system and that can
be achieved by a special diet. I would recommend about one kilo of curd made from
cow's milk and various types of gourds without salt. The greener the vegetables, the more
beneficial would be. Sour fruits like tomatoes, oranges, pineapples, rose apple, solanum
could be taken with advantage. The patient can also take one or two chapatis made of
flour which has not been passed through sieve. The person suffering from diabetes must

25

take long walks daily. Remember that the disease strikes generally those who lead a
sedentary life, and are used to rich diet poor in nutrition. Included in this kind of therapies
are Pranayama and Cleansing Processes. There are 8 types of Pranayama mentioned in
Hatha Yoga. One of the basic preparations for Pranayama is Nadi Shodhan Pranayama or
alternate nostril breathing. This type is found useful in diabetes as Alternate nostril
breathing has calming effect on nervous system, which reduces stress levels, helping in
diabetes treatment. Also research has shown that Bhramari and Bhasrika Pranayama help
in diabetes. Cleansing Processes or Master cleansing or Shankha Prakshalana is
recommended for diabetes, complete Shankha Prakshalana takes 1 day and is
recommended once in 6 months, but smaller version of it can be done 3 times a week.
This process cleanses the Gastro Intestinal tract completely. This process is done by
drinking 2 glasses of warm, salty water and lemon juice is added to it. Then performing 6
different exercises, this exercises speed up the peristaltic movements and one needs to
evacuate bowels. In 2 hours about 7 to 8 bowels are completed till the clear water is
evacuated (Wit, 2009).
Other CAM treatments may not lower blood glucose, but may help with
symptoms and complications of diabetes. Hyperbaric oxygen therapy (HBOT) helps
wounds heal. HBOT has greatly reduced the rate of foot amputations in several studies,
such as this one. Yet its rarely used. Aromatherapy (sometimes called essential oils
therapy or flower essence therapy) can help reduce stress symptoms and improve sleep.
Chiropractic and massage therapies can help reduce pain and improve mobility (Spero,
2008).

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Some people with diabetes use CAM therapies for their health condition. For
example, they may try acupuncture or biofeedback. The use of electronic devices to help
people learn to control body functions that are normally unconscious (such as breathing
or heart rate). The intent is to promote relaxation and improve health. To help with
painful symptoms is also one of its benefits (Halat, 2003).

Perception on Complementary Alternative Medicine

In a study on Knowledge, Attitude and Practice of Complementary and

Alternative medicines for diabetes in India, awareness of CAM among patients was high
(71%). High prevalence of CAM use was found (67.7%) among all participants, and 95%
among participants aware of CAM, mostly using 'naturopathy' (97.3% among users). No
significant gap (P>0.10) between knowledge and practice in different categories was
observed. Desire for quick and additional relief was the most common perceived reason
for using CAM (86.8%). Higher levels of education and socio-economic status were
significant positive correlates of CAM use. Knowledge of CAM was gained mainly from
friends and neighbors. About 30% of users adopted CAM without allopathic treatment
earlier. Only 42.2% of users perceived some relief by using CAM. Lowering of blood
sugar was the most common perceived relief. CAM, along with diet control and exercise,
resulted in maximum degree of satisfaction (61.9%) experienced by users. No relief was
experienced by 53.6% of users of 'naturopathy' (Bajaj, 2006).

Level of use of Complementary Alternative Medicine

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The use of CAM in addition to medical treatment is quite high in Turkey rather
than in addition to traditional medical care. In 1990, there were more visits to alternative
healers than to primary care MDs in the USA, yet over two-thirds of people who used
alternative medical treatments did not tell their doctors about such use. Non-medically
supervised use of CAM by patients can adversely affect diagnostic and treatment
decisions by treating physicians especially when they may be uninformed about
concomitant non-traditional therapies (Kumar et al., 2006).
As in any childhood chronic illness, the family and, in particular, the parents play
a major role in the childs diabetes self- management and health outcomes. Type 1
diabetes is a tremendously challenging and complex disease for children and families to
manage and is also cited as a disease for which the use of CAM is increasing worldwide.
As the use of CAM has grown dramatically in recent years, so has research on the safety
and efficacy of CAM treatments. Despite increasing use, there is little evidence to support
safety and efficacy of CAM in diabetes care found that certain health conditions were
highly associated with CAM use in adults, such as anemia (862%), diabetes (847%) and
migraine headaches (767%). CAM is most widely used by West Indians, Africans,
Indians, Latin Americans and Asians (Dham et al., 2006).
Pediatric use of CAM is generally increasing and frequency of pediatric use
ranges from 11% in Quebec to 70% in the northwestern USA. Another study of over 500
children in southwestern England reported that almost one in four children had received
CAM therapy and two studies in North America reported that over 10% of children had
used at least one form of CAM therapy. CAM therapy in children is usually associated
with parental CAM use (Gzm et al., 2007).

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Previous studies report varying results regarding the likelihood of CAM use in
pediatric diabetic patients and their parents in terms of socio demographic characteristics
did not find significant differences in age, sex, level of education between the patients
who used CAM and those who did. This is in contrast to studies by Kumar who did
indeed report significant variation in both the socio-economic status and education levels
of patients families with diabetes mellitus when comparing those who used CAM to
those who did not. CAM use is also high for in diabetic adults. In fact, one previous study
demonstrates that the use of any CAM modality was significantly higher for people with
diabetes (728% vs. 612%, p < 001) than for other conditions. Commonly used CAM
therapies for diabetes include prayer, acupuncture, massage, hot tub therapy, biofeedback
and yoga (Dham et al. 2006).
In a study, Use of Complementary and Alternative Medicine among Persons with
Diabetes Mellitus Ninety-five respondents reported having diabetes, of which 57%
reported CAM use in the past year; fewer respondents (35%) reported use specifically for
diabetes. Therapies used for diabetes included solitary prayer/spiritual practices (28%),
herbal remedies (7%), commercial diets (6%), and folk remedies (3%). Excluding solitary
prayer, only 20% of respondents used CAM to treat diabetes (Yeh, 2009).
In another study on Complementary and Alternative Medicine Use among Adults
with Diabetes in Muscat Region, Oman result showed that Sixty two (42%) of the
participants used CAM for the treatment of diabetes. Thirty (48%) were satisfied about its
use and 27 (43%) intend to use it again. The only types of CAM used by participants in
this study were herbs (n = 49, 79%), and/or food supplements (n = 7, 11%). Family and
friends (n = 47/62, 76%) and/or traditional healers (n = 19, 31%) were the main source of

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information on CAM in the treatment of diabetes. There was no significant correlation

between demographic characteristics and the use of CAM for diabetes (Al-Kindi, 2010).

The use of CAM among diabetics is common. A recent review of 18 studies from
9 countries showed that the prevalence of CAM use among patients with diabetes varied
from 17% to 72.8%. Most of the studies reviewed were conducted in developed countries
and the majority of papers were derived from the USA and Australia. In developing
countries, such as Saudi Arabia, 17.4% of patients with diabetes in Riyadh and 30% in
Mecca used some forms of herbs. In the United Arab Emirates, 76% of patients with
diabetes had previously used herbs and 38% were currently using some forms of CAM.
In Bahrain, 63% of patients with diabetes had used CAM within the previous 12 months.

Patients with diabetes are 1.6 times more likely to use CAM therapies than those
without diabetes. Recent data from the National Health Interview Survey determined that
~ 48% of patients with diabetes use some type of CAM treatment, and 22% use some
type of herbal product.2 Reasons for using CAM therapies are highly individualized
and widely varied. Side effects from conventional treatments, a need to have control over
ones health care, the ability to spend more time with alternative practitioners, and the
increasing costs of prescription medications are commonly cited reasons for using
alternative approaches (Geil, 2009).

Age and level of use of CAM

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Pediatric use of CAM is generally increasing and frequency of pediatric use

ranges from 11% in Quebec to 70% in the northwestern USA. Another study of over 500
children in southwestern England reported that almost one in four children had received
CAM therapy and two studies in North America reported that over 10% of children had
used at least one form of CAM therapy. CAM therapy in children is usually associated
with parental CAM use (Gzm et al. 2007).
Many of the rural older adults with diabetes included specific types and categories
of CAM therapies in their health self-management. These therapies were largely limited
to home remedies, vitamins, and minerals. Few (less than one in ten) of these rural older
adults used herbs, popular manufactured products, CAM therapies, or CAM practitioners.
Far more used CAM therapies for general use than they did for treating diabetes (Arcury,
2002).

Educational Attainment and level of use of CAM

Education may be an indicator of socioeconomic status, with those people having

high educational attainment also having the economic resources to purchase CAM
therapies. Education may also be an indicator of information access, which results in
more knowledge about specific CAM therapies. At the same time, lack of education, as a
socioeconomic status indicator, could result in less access to conventional medical care
and greater use of home and folk remedies (Arcury, Quandt, Bell, & Vitolins, 2002; Najm
et al., 2003). A large social network can provide information about the existence, and the
perceived efficacy, of different CAM therapies.

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Family Monthly Income and the level of use of CAM

Financial resources, such as economic status and health insurance status, affect
individuals' relative access to conventional care and their ability to pay for CAM
therapies (Astin et al., 2000; McMahan & Lutz, 2004; Najm et al., 2003). Many CAM
therapies are not covered by most current health insurance plans, indicating that people
with higher income will be better able to include them in their health self-management.
Astin and colleagues (2000) found fairly high levels of specific CAM therapy use (i.e.,
acupuncture, chiropractic) among older adults when these therapies were covered by
health maintenance organization membership.

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CHAPTER 3
Methodology

This chapter presents the research design, respondents, data gathering

instruments, validity and reliability of the instruments, data gathering procedure and
statistical treatment of the data.

Research Design

This study will utilize the Descriptive-Correlation Method as research design to

investigate and explain the relationship between the perception and use of
complementary alternative medicine among diabetics in Iloilo City.
Moreover, this study will explore the correlation between the age, sex,
educational attainment, marital status, occupation and family monthly income. A one-shot
survey design will be utilize in this study through the use of a researcher-made
questionnaire. This type of research methodology is a fact- finding procedure which
concerned with conditions or relationships that are existing, practices that are prevailing,
beliefs, attitudes and points of view that are held as well as trends that are developing. It

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attempts to organize, analyze and interpret data on the status of a thing or phenomena
(Good and Sactas).

Area and Population of the study

This study will be conducted among 50 diabetics in Iloilo City who are using
complementary alternative medicine as a treatment in their diabetes. The researchers will
be using the purposive sampling method.

Data Gathering Instrument

This study will utilize a researcher-made questionnaire for the assessment of the
perception and the level of use of complementary alternative medicine among diabetics.
The research instrument is divided into three parts, Part I will include the
respondents profile as to age, sex, educational attainment, marital status, occupation and
family monthly income.
Part II contains the perception of diabetic clients with the use of complementary
alternative medicine. The 10-item checklist will be answered through a 5-Likert scale
options; a score of (5) for Strongly Agree; (4) for Agree; (3) for a Not sure option; (2) for
Disagree; and (1) for Strongly Disagree. Further, the sum of scores will be categorized as

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Good Perception for a total score range of 37-50; Fair Perception for range 23-36;
and Poor Perception for range 10-23.
Part III will be the level of use of complementary alternative medicine among
diabetics in Iloilo City. The types of CAM used will be categorized as High level of
CAM Use when it is used for more than 5 years (2); and Low Level of CAM Use
when it is used for less than 5 years.
The instrument will be subjected to series of validation by experts in the field of
this study. Their corrections, comments, suggestions, and recommendations will be
incorporated in the final revision of the researcher-made questionnaire. Pre-testing will be
conducted to determine the accuracy and reliability of the questionnaire. The pre-tested
questions will be subjected to a reliability testing using the Cronbachs alpha reliability
coefficient test.

Data Gathering Procedure

Researcher will gather data for analysis. A letter will be secured to conduct the
study noted by the researchers and approved by the dean. Upon approval, the researchers
will present a letter to the respondents for the actual conduct of the study. Included in the
letter will be the purpose of the study, the information to be gathered and the manner of
answering the questionnaire.
The researcher will personally administer the questionnaire to the respondents.
They will be given an ample time to answer the question. Thereafter, results will be
tallied and tabulated. It will be reviewed for completeness and accuracy. Respondents are

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assured of the utmost confidentiality of the data. It is clearly explained to respondents

that the information given will be solely used for research purpose only.

Statistical Treatment and Analysis

Data gathered will be processed using the Statistical Package for Social Sciences
(SPSS) Software Program for Windows. It will also be analyzed using the percentage,
frequency and mean score for univariate data. Chi-square will be utilized to determine the
significance of the difference in the antecedent, dependent, and dependent variable in the
study. T-test and Pearson r will be used to determine the significance in the relationship
between the independent and dependent variables.The 0.05 level of significance will be
set.

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