Arjuna Medagama

The use of Complementary and Alternative Medicines (CAMs) in the treatment of diabetes mellitus: is continued use safe and effective?

IntroductionDiabetes mellitus is a major cause of morbidity and mortality worldwide, with a prevalence of 347 million in 2013. Complementary and Alternative Medicines (CAM) are a group of remedies that is fast gaining acceptance among individuals. Cinnamon, Bitter gourd (Momordica charantia) and Fenugreek (Trigonella foenum-graecum) are 3 widely used CAMs used worldwide for the treatment of diabetes. Data on safety and efficacy is limited, but the consumption is wide. Crepe ginger (Costus speciosus) and Ivy gourd (Coccinia grandis) are 2 plants used widely in the Asian region for their presumed hypoglycaemic properties.ObjectiveIn this review, we analyzed the available evidence for the 5 CAMs mentioned above in terms of in-vitro studies, animal studies sand clinical trials. We also describe the mechanisms of hypoglycaemia and safety concerns where there is available evidence.Results and conclusionsClinical trials that studied the hypoglycaemic effects of Cinnamon, bitter gourd, fenugreek and ivy gourd showed conflicting results. Direct comparison between studies remains a challenge in view of the baseline heterogeneity of subjects, differences in substrate preparation, variable end points and poor trial design. Short durations of study and small number of subjects studied is universal. Crepe ginger has not been studied adequately in humans to draw conclusions.In view of the high prevalence of use and safety and efficacy issues, there is an urgent need to study their hypoglycaemic and adverse effects in well-designed long-term clinical trials.

Use of Complementary and Alternative Medicines (CAMs) among type 2 diabetes patients in Sri Lanka: a cross sectional survey

BackgroundThe incidence of chronic illnesses has increased worldwide. Diabetes is one such illness and 80% of the diabetic population lives in the developing world. There is a rapidly growing trend towards the use of Complementary and Alternative Medical practices in Diabetes. Sri Lanka is a developing Asian nation with a rich culture of Ayurvedic and native medical culture.The objective of this study was to find the prevalence of use of CAMs in a diabetic population attending a large multiethnic diabetes facility in a University unit and to assess whether there is an increase in the incidence of hypoglycaemic episodes among users of CAMs.MethodsA cross sectional study was performed at Teaching Hospital Peradeniya between April and August 2012. Following verbal consent, 254 type 2 adult diabetic patients attending the diabetes facility were interviewed regarding the use of CAM and hypoglycaemia using an interviewer-administered questionnaire.ResultsOf the 252 valid results, 192 patients (76%) admitted to the use of a CAM to reduce blood glucose. Bitter gourd, ivy gourd and crepe ginger were used by 128, 113 and 92 individuals. While 19% used a single agent, 34%, 21% and 2.4% used 2,3 and more than 3 agents. The incidence of hypoglycaemia in CAM users was 21% and 16.6% in non-users. The difference was statistically not significant. (p = 0.57) Ingestion of Costus speciosus (Crepe ginger) was associated with higher incidence of hypoglycaemia (P = 0.01).Female gender was significantly associated with CAM use (p = 0.01), while the age, duration of diabetes, presence of co-morbidities and complications of diabetes failed to show a significant association.ConclusionSri Lanka has a very high use of herbal supplementation in type 2 diabetes patients. Although the overall incidence of hypoglycaemia is not increased among CAM users, crepe ginger is associated with significant hypoglycaemia and warrants further research.

Lack of infrastructure, social and cultural factors limit physical activity among patients with type 2 diabetes in rural Sri Lanka, a qualitative study

Introduction South Asians have high prevalence of diabetes, increased cardiovascular risk and low levels of physical activity (PA). Reasons for low levels of PA have not previously been explored among Asians living within their endogenous environment. This qualitative study was performed to explore the contextual reasons that limited PA among type 2 diabetic patients living in a rural community. Methods Purposeful sampling recruited 40 participants with long standing type 2 diabetes for this qualitative study. Semi-structered questions utilising in-depth interviews were used to collect data on PA patterns, barriers to PA and factors that would facilitate PA. The interviews were digitally recorded and transcribed. Data were analyzed using a framework approach. Results The sample consisted of 11 males and 29 females. Mean age was 55.4 (SD 8.9) years. The mean duration of diabetes in the study population was 8.5 (SD 6.8) years. Inability to differentitate household and daily activities from PA emerged as a recurring theme. Most did not have a clear understanding of the type or duration of PA that they should perform. Health related issues, lifestyle and time management, envronmental and social factors like social embarrassment, prioritizing household activities over PA were important factors that limited PA. Most stated that the concept of exercising was alien to their culture and lifestyle. Conclusion Culturally appropriate programmes that strengthen health education and empower communities to overcome socio-economic barriers that limit PA should be implemented to better manage diabetes among rural Sri Lankan diabetic patients.

Physical activity patterns and socio-demographic correlates of physical activity among medical undergraduates in Sri Lanka: an observational study

Background Physical inactivity is the fourth leading risk factor for mortality worldwide and a leading risk factor for type 2 diabetes and cardiovascular disease. Medical undergraduates are a group of young adults expected to have a sound knowledge of the benefits of physical activity (PA) and have an active lifestyle. Objective To quantifyPA levels among medical undergraduates of a Sri Lankan university and to determine the socio-demographic correlates of physical inactivity. Methods Medical undergraduates in their third, fourth and fifth years of study were recruited for this quantitative, descriptive, cross-sectional study using a self-administered questionnaire. Results A total of 421 students were recruited. Overall 41% were physically inactive. Females (47%) were more inactive than males (34%). The total mean weekly metabolic equivalent (MET)-minutes was 1468.2±1873. Males (1676.2±1629) had a higher mean weekly MET minutes than females (1319±20102), p=0.05. 88% owned a portable internet device such as a smartphone or tablet. Students using health-related apps on their devices had significantly higherPA (p=0.01) and lower body mass index (BMI) (p=0.04), than those who did not. Binary logistic regression revealed physical inactivity to be significantly associated with gender (p=0.01), not using a health-promoting app on their portable device (p=0.01) and the year of study (p=0.03). Conclusion Physical inactivity is a significant problem among medical undergraduates. The use of health applications was associated with a higher PA and lower BMI. The reasons for inactivity and the discrepancy in activity levels between males and females needs to be explored in greater detail.

An appraisal of food serving characteristics among patients with type 2 diabetes mellitus attending a tertiary care diabetes facility in Sri Lanka

Introduction: The primary objective of the present study was to identify the portion sizes of food consumed by adult type 2 diabetic patients in Sri Lanka and to evaluate if these were within the current recommendations. Materials and Methods: A cross sectional survey was performed at a tertiary care diabetes facility in Sri Lanka. Starch, fruits, vegetables, meat or alternative, pulses, dairy and added sugar consumption was assessed according to standard methods using a 24-hour dietary recall. Results: One hundred and twenty three randomly selected adult type 2 diabetic patients were studied. Forty six percent of participants exceeded the national recommendation of 4.5 to 9 servings of starch per day for patients with diabetes. Mean daily consumption of starch was 10.5 (median 10.2 IQR 4.7) servings. Only 26% and 45% of participants consumed the recommended 2 servings of fruits and 3 servings of vegetables per day. Thirty three percent and 8% did not consume any fruits or vegetables respectively. Dairy products were consumed by 25% only. Added sugar was not used by 99% of participants. Portion size was smaller in females and with advancing age. The mean proportions of total Carbohydrates, proteins and fats comprising total energy intake were 68.1%, 11.5% and 20.2% respectively. Discussion: Medical nutrition therapy in diabetes recommends a mixed diet with carbohydrates from a variety of sources such as cereals, fruits and vegetables. Although Sri Lankan patients with diabetes consume less starch and more fruits and vegetables compared to non-diabetic counterparts, a substantial proportion still fail to meet the recommendations.

A traditional Asian diet modified to meet nutritional requirements of diabetes, has anything changed? A cross-sectional dietary survey

BackgroundMedical nutrition therapy is the cornerstone of managing type 2 diabetes mellitus. Meals that are modified to suit diabetes should be culturally acceptable, retain palatability and conform to the energy requirements of diabetes. The objective of this study was to find if the dietary patterns of Sri Lankan type 2 diabetes patients have changed from the traditional serving characteristics to align with dietary recommendations of diabetes, while retaining palatability and cultural acceptability.MethodsA cross-sectional survey was performed at a multi-ethnic, tertiary care diabetes facility in Sri Lanka. Fruits, vegetables, starch, pulses, dairy and added sugars in diet were assessed with portion size estimation using a 24-h dietary recall according to standard methods.ResultsThe meals consumed by participants were “traditional” and retained palatability. Rice contributed to 93% of the starch-based food types. Ninety-two percent consumed starch in excess of the daily recommendation. Fruit and vegetable consumption was 1.3 and 2.8 servings per day, with 33% failing to consume any fruit. Seventy-four percent and 65% of participants failed to consume the minimum daily recommended number of fruit and vegetable servings. Only 1% of participants consumed added sugar.ConclusionsThe Sri Lankan diabetes diet is a portion-restricted version of the traditional meal that retained cultural acceptability and palatability. A large proportion of patients still consume carbohydrates in excess of the recommendations. Although there is an increasing trend towards fruit and vegetable consumption, the majority still fell short of the recommendations.