According to previous studies conducted in Canada, Australia, Denmark and Turkey, nearly half of parents
8,
9,
10,
16) and, to studies conducted in USA and New Zealand, approximately 20-40% of parents (
11,
12,
13,
14,
15) reported using one CAM method sometime in their lives.
The number of studies on use of CAM in T1DM patients is limited. Miller et al (
17) and Dannemann et al (
18) reported that the frequency of CAM use in children with T1DM was 19% in the USA and 18.4% in Germany. Even though the rate in our study was found to be relatively higher than that estimated in other countries, this rate was compatible with the results of studies conducted in the general population and in children with chronic disease (
16,
19), as well as in children with T1DM (
36) in Turkey. The high rate of CAM use in our patients may be due to the chronic nature of the disease, its labile course and the complexity of the medical treatments, which may have been the factors that led these parents to search for new ways of treatment to achieve better control (
20,
21).
In our study, the most frequently mentioned CAM method was administration of herbs. This finding was consistent with the results of some of the studies reported from the USA (
12,
14) and of many studies from Turkey and other countries (
16,
19,
22,
23,
24,
25,
26,
27). Dannemann et al (
18) found that herbs, homeopathy and vitamins were the most commonly applied CAM methods, while Miller et al (
17) noted in their study that religious practices, use of herbs and vitamins were the most frequent ones. In our country, Arikan et al (
36) reported that herbs were the most commonly used CAM method (59.6%), a finding also compatible with our results. Only 4 patients in our study had used homeopathy, naturopathy, or chiropraxy, which are methods more popular in other countries. The high cost of these practices may be the reason why they are not so preferred in Turkey. As to the type of herb used, Dannemann et al (
18) reported that cinnamon and aloe vera were the most commonly used ones, while Arikan et al (
36) found that aloe vera, stinging nettle and mulberry were the herbs most frequently given to children with T1DM. In our study, the most commonly administered types were thyme juice, stinging nettle, cinnamon and aloe vera. Others have also reported that cinnamon and aloe vera are especially popular for the treatment of DM (
29,
30,
31). Although many studies showed that the use of CAM was directly proportional to the education level of the mothers (
14,
16,
18,
28) and the level of income of the family (
8,
9,
18), Pitetti et al (
11) and Miller et al (
17) did not find that these factors had a significant effect. In contrast, Arikan et al (
36) observed that the use of CAM decreased as the education level of the mother and the socioeconomic status of the family increased. It was also reported that the use of CAM by the parents themselves was a factor which increased the rate of use of CAM in their children
16,
17,
32,
33). In our study, the use of CAM by the parents themselves was found to be directly proportional to the use of CAM in their children. Although we did not detect any correlation between CAM use and education level of the parents, the use of CAM was found to be significantly higher in families having a high level of income and living in the big cities, a finding consistent with previous studies. We also found that when the parents were asked about using CAM if their children had cancer, the rate of use of CAM would increase from 43.6% to 71.3%. This result may be indicative of the parents’ view about DM as a treatable disease, even if it takes a lifetime. The risk of most complications of DM decreases with an adequate treatment, while cancer is perceived as a much more mortal disease by the families. The use of CAM was found to be significantly higher in patients with complications and in those with concomitant diseases. This finding may be due to increased anxiety in the parents when faced with a complication or an accompanying disease. In our study, religious beliefs were found to be important factors encouraging the family to use alternative treatment methods that were mostly applied to support the medical treatment. In our series, there were only 3 families who quit the medical treatment to use CAM. Dannemann et al (
18) reported that the most commonly expressed reasons for using CAM was “to try everything” and “their having fewer side effects”.
As to source of information about CAM, we found that the majority of the parents had learnt about CAM from their friends and relatives. This finding is compatible with the results of similar studies in our country, while the media and internet are reported as the most common sources of information about the CAM methods in Western countries (
16,
34,
35). In our study, a few patients got the information from their doctors, but only 18.8% of the families shared this with their doctors. Ozturk et al (
16) and Arikan et al (
36) reported similar results, while the rate estimated by Dannemann et al (
18), for sharing the information on use of CAM with their doctors, was much higher. Also in Dannemann’s study, the parents stated that only 37.3% of the doctors advised their patients to leave the alternative treatment. The patients who did not tell their doctors about the use of CAM commented that their reason for not telling was that their doctors would not understand (
18). In this present study, when the parents were asked their opinion on the use of CAM, half of them said that they found them beneficial. This ratio was reported as 71.7% by Ozturk et al (
16), as 53.8% by Arikan et al (
36), and as 62.5% by Dannemann et al (
18). In all these studies, the issue of usefulness was evaluated by discourse with the families, i.e. subjectively, and was not based on objective criteria such as a decrease in the dosage of insulin or level of HbA1c. Our study indicates that, similar to its practice in other chronic diseases, CAM is frequently used in children with T1DM. As also shown in other studies from Turkey, herbs are the most commonly administered substances in our country. It also appears that when problems occur in the course of the disease, the rate of use of these substances increases. Studies are needed to determine their efficacy, safety, as well as the potential herb-drug or vitamin-drug interactions and to examine the side effects that can occur due to these interactions. In conclusion, pediatricians should communicate with the patients about the CAM methods and inform them about their benefits, harms and possible contraindications.
1 Pınar İşgüven,2 Metin Yıldız,2 İlknur Arslanoğlu,3 and Müferet Ergüven4
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