|Year : 2014 | Volume
| Issue : 3 | Page : 137-140
Prevalence of using herbal drugs as anti-diabetic agents in Taif Area, Kingdom of Saudi Arabia
Abeed S Algothamy1, Wadia S Alruqayb2, Mustafa A Abdallah2, Khaled M Mohamed3, Ahmed A Albarraq2, Ibrahim A Maghrabi2
1 Department of Pharmacy, King Faisal Hospital, Taif, Kingdom of Saudi Arabia
2 Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Al-Haweiah, Kingdom of Saudi Arabia
3 Department of Pharmacognosy, College of Pharmacy, Taif University, Taif, Al-Haweiah, Kingdom of Saudi Arabia; Department of Pharmacognosy, Faculty of Pharmacy, Assiut University, Assiut, Egypt
|Date of Web Publication||7-Oct-2014|
Khaled M Mohamed
Department of Pharmacognosy, College of Pharmacy, Taif University, Taif, Al Haweiah, P. O. Box 888, Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Objectives: To evaluate the frequency and prevalence of using herbal drugs in treatment of diabetes in Taif area, Kingdom of Saudi Arabia. Materials and Methods: Structured questionnaire was the main instrument used to collect information to evaluate the attitude of respondents towards use of herbal medicine. In all, 228 diabetic patients were subjected to this study from clinics in 3 major hospitals in Taif - KSA (King Faisal Hospital (KFH), King Abdul-Aziz Hospital (KASH), Alhada Armed Forces Hospital over a 4-month and 20-day period. Results: Out of the 228 diabetics, (24.6%) of those patients were using herbs, more than half of them 31 (55.4%) were males and half of them 28 (50%) and were aged 50 years and above. Interestingly, when exploring the commonly used herbs, a total of 20 different herbal names were reported to be used by the surveyed diabetics. The top four used herbs were fenugreek, nigella, myrrh and garlic with a frequency of 57.1, 44.6, 42.9 and 32.1%, respectively. Conclusion and recommendation: About one-fourth of diabetic patients in this study were using herbs and the most frequently used herbs were fenugreek, nigella, myrrh and garlic. Pharmacists should be referred for consultation regarding the use of herbal remedies. In addition, knowledge about herbal drugs should be updated to the pharmacists and physicians through continued scientific programs. Public awareness about herbal remedies should be considered to guide the public for the trusted and safe source of information when it is needed.
Keywords: Antidiabetic herbal drugs, Kingdom of Saudi Arabia, prevalence, Taif
|How to cite this article:|
Algothamy AS, Alruqayb WS, Abdallah MA, Mohamed KM, Albarraq AA, Maghrabi IA. Prevalence of using herbal drugs as anti-diabetic agents in Taif Area, Kingdom of Saudi Arabia. Saudi J Health Sci 2014;3:137-40
|How to cite this URL:|
Algothamy AS, Alruqayb WS, Abdallah MA, Mohamed KM, Albarraq AA, Maghrabi IA. Prevalence of using herbal drugs as anti-diabetic agents in Taif Area, Kingdom of Saudi Arabia. Saudi J Health Sci [serial online] 2014 [cited 2023 Feb 7];3:137-40. Available from: https://www.saudijhealthsci.org/text.asp?2014/3/3/137/142319
| Introduction|| |
Diabetes Mellitus (DM) constitutes a major public health problem in Saudi Arabia. It is unique that prevalence in males is significantly higher than females, with a prevalence of 34.1% and 27.6 for males and females, respectively. 
The use of complementary and alternative medicine is practiced for chronic diseases, either for trying to cure them or to slow down its progression and to prevent their complications. DM is a chronic disease so that the goal of its management is usually to prevent the progression and complications of the disease. Many diabetic patients use herbs besides conventional treatment in Saudi Arabia. 
The side effects of prescribed hypoglycemic agents is not the main cause of using herbal medicines, but it can be for cultural reasons  , fast relief of symptoms and inhibiting the progression of the disease. , Furthermore, the use of herbal medicines was used as a supportive but not an alternative or due to the side effects of conventional medicine. , The commonly used herbs were black seed (nigella), fenugreek, garlic and cinnamon throughout literature.  A Turkish study  declared that the commonly used herbs were garden thyme and pomegranate syrup in addition to cinnamon, which was also used with ginseng in a combination with Chinese herbs in a study conducted in Taiwan and its action was thought to decrease insulin resistance. , Interestingly, a Palestinian study  summated almost all the commonly used herbs in the previously mentioned studies , except the traditional Chinese herbs.  Myrrh and Aloe were mentioned by both Saudi  and Palestinian  studies.
| Materials and methods|| |
The pilot study was of 20 cases of diabetic patients to establish face validity and identify any questions that needed to be altered prior to using the questionnaire in the main study.
Structured questionnaire was approved by the Research Ethical Committee, College of Pharmacy, Taif University, KSA. It was the main instrument used to collect information to evaluate the attitude of respondents towards use of herbal medicine.
In all, 228 diabetic patients were subjected to this study from clinics in 3 major hospitals in Taif - KSA (King Faisal Hospital (KFH), King Abdul-Aziz Hospital (KASH), Alhada Hospital (one of the biggest armed forces hospitals) over a 4-month and 20-day period which started in 2/1/2012.
All diabetic patients attending the hospital were included. Patients were asked to be interviewed and patients accepted with a response rate of 86% of the whole number and gave further information after their verbal consent.
Patients were interviewed by trained Pharmacy students studying in 6 th year with help from patient educators and nurses in the hospital's clinics. They were asked with regards to their demographic data (sex, nationality, living area, age) and diabetes - type, duration, origin, presence of complications, treatments, follow-up, control of diabetes and whether they had used herbal medicine or not. If the answer was yes to the last question, then they were asked further questions regarding the herbal medicine such as its type, frequency of use, form, how to use, who prescribed it, its side effects (if any), patient satisfaction with it, (response or not) if the patient had used it along with a prescribed medicine and if he/she had informed his/her physician regarding the use of this herbal treatment and what about his/her opinion recorded regarding continuing its use and prescribing other medicines.
Data entry and statistical analysis
Data were collected, coded and analyzed using Statistical Package for the Social Sciences software (SPSS software version 18) under windows 7, simple descriptive analysis in the form of percentage was done.
| Results|| |
From the 228 interviewed diabetics, (24.6%) of those patients were using herbs. [Table 1] shows the basic demographic characteristics of the participants. A total of 56 diabetic patients who had used herbs, more than half of them 31 (55.4%) were males and half of them 28 (50%) were females and aged 50 years or above. The majority of the interviewed diabetics 52 (92.2%) were Saudi nationals and most of the total participants 35 (62.5%) lived in urban areas.
Surprisingly, about one-third 19 (33.9%) of the surveyed diabetics were illiterate. More than half of the interviewed diabetics 32 (57.1%) admitted that they had type (II) diabetes and almost the same proportion 31 (55.3%) had reported the presence of family history of diabetes mellitus.
Interestingly, when exploring the commonly used herbs, a total of 20 different herb names were reported to be used by the surveyed diabetics [Figure 1]. The top four used herbs were fenugreek, nigella, myrrh and garlic with a frequency of 57.1, 44.6, 42.9 and 32.1% respectively. Other herbs reported by the participants showed in [Figure 1].
[Figure 2] and [Table 2] illustrate that greater majority of the study participants were recommended herbal remedies by their friends or their peer diabetic patients which had shown a similar frequency of 24 (42.2%) for the former and the latter, while only 6 (10.7%) had reported that they were advised by a spice dealer. Surprisingly, none of the responders asked pharmacists about herbs and only 2 (3.6%) did ask the physicians.
|Figure 2: Reported sources of knowledge about herbs by interviewed diabetics|
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Regarding the experience of the participants during their use of herbs, most of them 40 (71.4%) used the herb after boiling, while only 5 (8.9%) used them in a powder form. In addition, about one-third of them 18 (32.1%) take herbs when they felt that there was a necessity for taking them while 6 (11.0%) had them several times a day and a similar frequency of the interviewed patients 15 (26.8%) was reported that they took the herbs daily or weekly.
The results showed that, only 10 (17.9%) of the respondents had complained of side effects. About one-third 19 (33.9%) of the diabetics who used herbs had informed their physicians, of whom, only 5 (8.9%) had reported that their physicians disapproved their use of herbs, two physicians (3.6%) approved the use and surprisingly 12 (21.4%) had reported that their physicians did not object to their use of herbs.
| Discussion|| |
The prevalence of using herbs by diabetics in the present study was 24.6% and compared to prevalence of 17.4%  , the current study had clearly shown the rise of the prevalence of using herbs among diabetics over the last decade in KSA. Furthermore, it provides a good indicator of the rise in prevalence of using herbs among diabetics as an adjuvant second line therapy for controlling their blood glucose.
Due to the cost and in some occasions the known side effects or even the delayed response  of the formulated medicines, patients resort to the herbal remedies which were usually mislabeled by the public or the sellers as safe and free from side effects assuming that these natural products had at least fair efficacy in the management of diabetes. This safeness of herbal medicines could be a false one and this belief could be attributed to the underuse and lack of scientific studies that prove their safety and efficacy. Interestingly, the side-effects of conventional therapy were not a major cause for using herbs. ,,, On the contrary, some herbs were classified as food by drug and food authorities in this case the concern goes towards their efficacy and food drug interaction.
The commonest used herbs by the study respondents were fenugreek, nigella, myrrh and garlic, which goes in concordance with studies conducted in the Middle East , and specifically Saudi Arabia  that had the same use of herbs except for garlic. However a Turkish study  reported the dominance of garden thyme and pomegranate syrup. A study conducted in Taiwan had reported the use of formulas that contained mainly cinnamon and ginseng added to a mixture of traditional Chinese herbs.  These traditional Chinese herbs need to be studied because of the fact that those herbs could be synonyms or Chinese names of already known herbs.
The commonest form of using herbs in this study was boiling (71.4%), interestingly this result is in agreement of a Palestinian study  with a rate of (79.5%).
Giving evidence of the lack of the role of healthcare professionals regarding guiding and advising diabetics about the use of natural products, the current study reported that only 3.6% had consulted a physician for their use of herbs while none of them reported asked a pharmacist about using herbs. On the contrary, family members (42.2%) and friends (42.2%) represented the main sources of information about herbs as reported by interviewed diabetics who used herbs. This result is not different from other Middle East countries, for instance in Jordan  it was concluded that close relatives and friends were the main source of information about herbs by 41.6% and 25.6% respectively. Herbal products and herbal plants are diverse and they need a specialist look to describe their potential or actual risks and benefits. Having stated that, there should be an inclusion of the knowledge about herbal drugs not only for the pharmacists, but also for physicians. The emerging concept of the pharmaceutical care raised untraditional and extended roles for the pharmacist practitioners from just preparation and dispensing of medicines to all aspects that affect therapeutic outcomes of each particular disease and tailor the management to the patient's individual circumstances. 
The unsupervised use of natural products by diabetic patients can lead them to stop their already prescribed medications  which could lead to drastic consequences. For diabetic patients, if the herb was not effective, this could lead to worsening of hyperglycemia and might lead to Diabetic Ketoacidosis. On the other hand if the herb was highly effective it might lead to hypoglycemia which can lead to permanent brain damage in its severe form. This risk is expected to be lower when using portable personal glucometer.
| Conclusions and recommendations|| |
A 24.6% of diabetic patients in this study were using herbs and the most frequently used herbs were fenugreek, nigella, myrrh and garlic. Pharmacists should be referred for consultation regarding use of herbal remedies. Therefore, herbal and alternative medicine should be taught to undergraduate pharmacists and this knowledge should be updated and reinforced after graduation by the programs of continual professional development for pharmacist as well as physicians.  These programs ought to include the commonly used herbs, their efficacy, safety and interactions. In addition, clinical trials should be implemented to study safety and efficacy of these herbal medicines. ,,
Public awareness through different media and locations should be done to communicate the perceived risk of the herbal remedies and guide the public on the trusted and safe source of information when it is needed. Public campaigns could reduce the demand and misuse of herbal remedies.
| Acknowledgement|| |
The authors high appreciate Dr. Ahmad Alghamdi and Dr. Moshrif Alghamdi for their partcipation in data collections.
| References|| |
|1.||Alqurashi KA, Aljabri KS, Bokhari SA. Prevalence of diabetes mellitus in a Saudi community. Ann Saudi Med 2011;31:19-23. |
|2.||Al-Rowais NA. Herbal medicine in the treatment of diabetes mellitus. Saudi Med J 2002;23:1327-31. |
|3.||Wazaify M, Alawwa I, Yasein N, Al-Saleh A, Afifi FU. Complementary and alternative medicine (CAM) use among Jordanian patients with chronic diseases. Complement Ther Clin Pract 2013;19:153-7. |
|4.||Ali-Shtayeh MS, Jamous RM, Jamous RM. Complementary and alternative medicine use amongst Palestinian diabetic patients. Complement Ther Clin Pract 2012;18:16-21. |
|5.||Mehrotra R, Bajaj S, Kumar D. Use of complementary and alternative medicine by patients with diabetes mellitus. Natl Med J India 2004;17:243-5. |
|6.||Huang CY, Tsai YT, Lai JN, Hsu FL. Prescription pattern of Chinese herbal products for diabetes mellitus in Taiwan: A population-based study. Evid Based Complement Alternat Med 2013;2013:201329. |
|7.||Ching SM, Zakaria ZA, Paimin F, Jalalian M. Complementary alternative medicine use among patients with type 2 diabetes mellitus in the primary care setting: A cross-sectional study in Malaysia. BMC Complement Altern Med 2013;13:148. |
|8.||Wazaify M, Afifi FU, El-Khateeb M, Ajlouni K. Complementary and alternative medicine use among Jordanian patients with diabetes. Complement Ther Clin Pract 2011;17:71-5. |
|9.||Ceylan S, Azal O, Taºlipinar A, Türker T, Açikel CH, Gulec M. Complementary and alternative medicine use among Turkish diabetes patients. Complement Ther Med 2009;17:78-83. |
|10.||Al-Arifi MN. Availability and needs of herbal medicinal information resources at community pharmacy, Riyadh region, Saudi Arabia. Saudi Pharm J 2013;21:351-60. |
|11.||DiNardo MM, Gibson JM, Siminerio L, Morell AR, Lee ES. Complementary and alternative medicine in diabetes care. Curr Diab Rep 2012;12:749-61. |
[Figure 1], [Figure 2]
[Table 1], [Table 2]