4

CHAPTER 1Introduction

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 duringpregnancy.

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 anysymptoms (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, orboth. 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 heartproblems (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 etal, 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 self-management 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 FrameworkThis study will be anchored to the Theory of Reasoned Action by Martin Fishbein andIcek Ajzen(1980). The key application of the theory of reasoned action is prediction ofbehavioral intentions, spanning predictions ofattitudeand predictions of behavior. The subsequent separation of behavioral intention from behavior allows for explanation of limiting factors onattitudinal 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.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

VariableIndependent

Variable

Perception

ProfileOn

CAM

Age

Sex

Educational Attainment

Marital Status

Occupation

Family Monthly IncomeDependent

Variable

Level of Use

of

CAM

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

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.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.

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 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.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 specificScope 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.

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.CHAPTER 2

Review of Related LiteratureDiabetes 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 duringpregnancy.

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 insulina 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 cholesterollevels. (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 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 anysymptoms (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), 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, orboth.

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 health-care 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 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., andpolyphenols (Halat, 2003).

Alpha-lipoic acid (ALA, also known as lipoic acid or thioctic acid) is an antioxidanta 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 orcapsules. 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 factsheet.) Because ALA might lower blood sugar too much, people with diabetes who take it must monitor their blood sugar levels verycarefully (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 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 chromiumnicotinate. 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 isneeded. 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 withdiabetes (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 triglyceridelevels.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 specifically at heart disease in people with diabetes, isneeded. 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 bloodpressure (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 useinsulin. 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 sucheffects. 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, lesseffective (Collins, 2007).

Other supplements are also being studied for diabetes-related effects. Forexample: Preliminary research has explored the use of garlic for lowering blood glucose levels, but findings have not beenconsistent. 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 ofdiabetes. There is not enough evidence to evaluate the effectiveness of coenzyme Q10 supplementation as a CAM therapy for diabetes; studies of its ability to affect glucose control have had conflictingfindings. 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 glucoselevels. 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 fordiabetes (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 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 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).

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

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 etal., 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 etal., 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 etal., 2007).

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