slides current until 2008 complementary therapies

Slides current until 2008

Complementary therapies

Complementary therapiesCurriculum Module III-8

Slide 2 of 24ACTIVITY


• What complementary therapies (CAM) are available in your country?

• What herbs are commonly used to lower blood glucose?

• What percentage of people in your country use CAM?


Slide 3 of 24


What affects health?

• Individual risk factors for disease• People’s social situation• Social health indicators and the

health conditions people develop are influenced by:– attitudes and beliefs– culture/custom e.g. illness as

an outcome of a curse– resources– diet and exercise habits


Slide 4 of 24


What are complementary therapies?

• Generally refers to therapeutic and diagnostic disciplines outside conventional medical practice

• Covers a wide range of therapies from well-accepted practices, such as acupuncture and massage, to ‘fringe’ therapies, such as crystal therapy

• Boundaries within and between CAM and conventional therapies are not always well defined and change over time


Slide 5 of 24


Underlying complementary therapy philosophy

• The body has the capacity to heal itself• Healing the person is not curing the disease• Balance and harmony are essential• The purpose of interventions is to restore

balance• The patient is a unique individual and an

active participant in their health care• The therapist/patient relationship is

important• Self-efficacy is important• Illness represents both a threat and an

opportunity


Slide 6 of 24


Who uses complementary therapies?

• People in poor health with chronic diseases

• People committed to the environment• Well-educated women (67%), interested

in self-care, involved in their own health care

• People with philosophies and values congruent with CAM

• People who often seek CAM after a traumatic event and on the advice of family and friends

• People who think it is culturally relevant


Slide 7 of 24


Pathways to complementary care

• Base choices on knowledge, beliefs, experience and the advice of others

• Often combine complementary therapies• Combine complementary and

conventional therapies• Self-diagnose or diagnosed by the family

or friends and self-treat• Some are disenchanted with conventional

medicine• Conventional therapies are not available

or affordable


Slide 8 of 24


Do people with diabetes use complementary therapies?

Percentage of people attending a diabetes outpatient clinic using CAM• 17% in the UK (Leese et al 1997)• 25% in Canada (Ryan et al 1999)• 20% in Australia (Dunning 2003)People with diabetes are 1.6 times more likely to use CT than people without diabetes (Egede et al 2002)More than 50% of Asians use herbs or traditional therapies for diabetes – with or without conventional therapy (personal communication)


Slide 9 of 24


Conventional practitioner fears

• ‘There is no evidence of effectiveness or safety’

• Uncontrolled demand for complementary therapies

• Self-diagnosis and self-treatment could cause adverse events

• Uncoordinated care• Changed income and power basis• Range of therapies available through

the Internet• CAM could be used instead of

conventional therapies


Slide 10 of 24


Complementary practitioner fears

• Conventional practitioners do not understand complementary therapies and the underlying philosophy

• As complementary therapies become conventional, they will be lost to conventional practitioners


Slide 11 of 24


Important issues

• Safety of people with diabetes e.g. unwanted side effects

• People have enough information to make an informed choice

• Education, knowledge and competence of the practitioner

• Administrative issues, policies and guidelines

• Communication, collaboration and referral systems

• Cost/benefit


Slide 12 of 24


Important issues

• The therapies used may not be applicable to the individual’s needs and health issues

• Research and evaluation of the therapy may be lacking

• History of safe traditional use

• Administrative considerations


Slide 13 of 24


Important issues

• Availability of complementary and conventional consultant advice

• Professional standards

• Legal and regulatory requirements

• Professional self-regulation

• Liability, insurance, and indemnity


Slide 14 of 24


Important issues

• Evidence base for many complementary therapies is not established

• Product quality control and labeling is often deficient

• Some products are contaminated or adulterated and there are dose variations between batches

• Potential for herb/drug and herb/herb interactions and interactions with and between supplements


Slide 15 of 24


Adverse events associated with CAM used by people with diabetes

• Stopping insulin in type 1 diabetes, leading to ketoacidosis

• Trauma and burns from moxibustion and cupping on neuropathic legs

• Hypertension

• Bruising from massage

• Allergies

• Inappropriate weight loss

• Renal and hepatic toxicity


Slide 16 of 24


• Hypoglycaemia from inappropriate dietary interventions

• Hypoglycaemia from combining traditional Chinese herbs with conventional oral blood glucose-lowering medicines

• Hyperglycaemia following the use of some forms of spirulina

• Infected burns from hot foot baths requiring hospitalization and intravenous antibiotics

Adverse events associated with CAM used by people with diabetes


Slide 17 of 24


Are there any benefits for people with diabetes?

• Help people accept diabetes• Education and counseling to aid

concentration and make links between new and existing information

• Preventive care to encourage lifestyle modification i.e. diet, exercise, smoking

• Reduce stress and thus improve blood glucose control

• Improve self-esteem and well-being• Some directly reduce blood glucose and

blood fats• Analgesia• Foot care


Slide 18 of 24


Core elements of integrating complementary and conventional care

• Principles of holism understood, embraced and applied

• A spectrum of health options offered

• Therapeutic relationship seen as a vital aspect of care

• Practitioner’s own health crucial

• Treatment of disease only a small aspect of wellness

• Knowledge of CAM and appreciation of the diversity of CAM


Slide 19 of 24


Core elements of integration

• Share information and negotiate action plan with achievable goals

• Focus on empowerment

• Framework of clear communication and cooperation

• Appropriate education

• Appropriate self-monitoring


Slide 20 of 24


What is needed?

Common ground: is there any?

• Increasing the incorporation of CAM into conventional curricula, conferences and mainstream healthcare journals

• Safe environment for change

• Cannot just graft one onto the other; need for interdisciplinary co-operation


Slide 21 of 24


Information for people with diabetes

• First, have a correct diagnosis• Decide your health goals• Select therapies likely to achieve these

goals• Learn all there is about them• Consult reputable practitioners • Buy products from reputable sources• Make sure these have labels that

describe the product• Inform conventional and complementary

practitioners• Monitor outcomes• Adjustments may be needed




• How do you feel about the use of CAM by people with diabetes?

• Should complementary and conventional therapies be integrated?

• How could that occur in your area?

• What would an integrated model of care look like?




• Would CAM become conventional if they were integrated?

• Is it good practice to provide more healthcare options?

• Can your health system/society afford it?

• Who should pay?

• Who should monitor quality and efficacy of CAM?


Slide 24 of 24


References

1. Goudie A, Kayes. Contaminated medication precipitating hypoglycaemia. Med J Aust 2001; 175: 256-7.

2. Leese G, Gill G, Houghton G. Prevalence of complementary medicine usage within a diabetic clinic. Practical Diabetes International 1997; 14(7): 207-8.

3. Ryan E, Pick M, Marceau C. Use of Alternative Therapies in Diabetes Mellitus. Proceedings of the American Diabetes Association Conference 1999; San Diego, USA.

4. Dunning T. Complementary therapies and diabetes. Complement The Nurs Midwifery 2003; 9: 74–80.

5. Egede L, Xiaobou Y, Zheng D, Silverstein M. The prevalence and pattern of complementary and alternative medicine use in individuals with diabetes. Diabetes Care 2002; 25: 324-9.

6. MacLennan A, Wilson P, Taylor A. Prevalence and cost of alternative medicines in Australia. Lancet 1996; 347: 569-73.

7. Gill G, Redmond S, Garratt F, Paisley R. Diabetes and alternative medicine: cause for concern. Diab Med 1994; 11: 210-3.

Recommended reading:1. Dunning T. Complementary therapies: considerations for diabetes care. Practical Diabetes International 2004;

21(3).

2. Vincent C, Furnham A. Complementary Medicine – a Research Approach. Wiley, New York, 1997.

3. Dunning T. Complementary Therapies in Diabetes and vascular Disease. Wiley, Chichester 2006.

4. Bodeker G, Burford G. Traditional, Complementary and Alternative Medicine. Imperial College Press, Oxford UK 2007.

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