Self Medication and Use of Dietary Supplements in Adult Patients with Endocrine and Metabolic Disorders

Abstract

Introduction:

Patients often use dietary supplements in addition to the therapies prescribed by their physicians. This self medication is often not listed in the drug history. We supposed that people, who are more afraid of co-morbidities or diabetes late complications and who exhibit a higher fear of the potential side effects of prescribed drugs, are more inclined to use dietary supplements.

Patients and Methods:

We checked the use of dietary supplements with a standardised questionnaire in patients treated in a centre for endocrinology and metabolic diseases. Demographic and clinical data were taken from the electronic health record EMIL^®.

Results:

A total of 428 patients (51.4% women), mean age 58.3 years, completed the standardised questionnaire. Supplements were used by 41%: Mineral nutrients 60.2%, vitamins 56.8%, “other supplements” (e. g. omega-3-fatty acids, antidiabetic agents) 43.1% and medical herbs 35.1%. The users of supplements were predominantly women (p<0.001), non-smokers (p=0.004), persons with frequent medical appointments (p=0.014) and with a negative attitude towards the effectiveness of the physician prescribed medication (p=0.012). Patients with diabetes do not use supplements more often than patients without. The use of dietary supplements was not associated with patients’ fear to develop co-morbidities of existing diseases (p=0.132) or a higher fear of side effects of prescribed drugs (p=0.099).

Conclusions:

Nearly half of the patients in a centre for endocrinology and metabolic diseases use self medications with dietary supplements. There is no association between the fear of co-morbidities or side effects of physicians prescribed drugs and a self medication with dietary supplements.

Key words

dietary supplements - diabetes - hypertension - metabolic diseases - complementary and alternative medicine (CAM)

• References

• 1 Schleiter A. Glück, Freude, Wohlbefinden - Welche Rolle spielt das Lernen? Ergebnisse einer repräsentativen Umfrage unter Erwachsenen in Deutschland. Gütersloh: Bertelsmann-Stiftung; 2008: 6-9 www.bertelsmann-stiftung.de/bst/de/media/xcms_bst_dms_23599_23600_2.pdf
• 2 Mensink G. Ernährung und Gesundheit. In: Mensink G, Burger M, Beitz R, Henschel Y, Hintzpeter B. Beiträge zur Gesundheitsberichterstattung des Bundes- Was essen wir heute?- Ernährungsverhalten in Deutschland. Berlin: Robert-Koch-Institut; 2002: 9-10
• 3 Rütten A, Abu-Omar K, Lampert T et al. Gesundheitsberichterstattung des Bundes Heft 26 – Körperliche Aktivität. Berlin: Robert-Koch-Institut, Statistisches Bundesamt; 2005: 8-11 http://edoc.rki.de/documents/rki_fv/ren4T3cctjHcA/PDF/29BFVzVHbIM_45.pdf
• 4 Goh LY, Vitry AI, Semple SJ et al. Self-medication with over-the-counter drugs and complementary medications in South Australia’s elderly population. BMC Complement Altern Med 2009; 9: 42
• 5 Woolf AD, Gardiner P. Use of complementary and alternative therapies in children. Clin Pharmakol Ther 2010; 87 (02) 155-157
• 6 Alves C, Lima RV. Dietary supplement use in adolescents. J Pediatr (Rio J) 2009; 85 (04) 287-294
• 7 De Silva A, Samarasinghe Y, Senanayake D et al. Dietary supplement intake in national-level Sri Lankan athletes. Int J Sport Nutr Exerc Metab 2010; 20 (01) 15-20
• 8 NVS- Nationale Verzehrsstudie II – 5.8 Nährstoffzufuhr über Supplemente. In: Ergebnisbericht Teil 2, Die bundesweite Befragung zur Ernährung von Jugendlichen und Erwachsenen. Karlsruhe: Max-Rubner-Institut, Bundesforschungsinstitut für Ernährung und Lebensmittel, Bundesministerium für Ernährung, Landwirtschaft und Verbraucherschutz; 2008: 143-158 http://www.was-esse-ich.de/uploads/media/NVSII_Abschlussbericht_Teil_2.pdf
• 9 Li K, Kaaks R, Linseisen J et al. Consistency of vitamin and/or mineral supplement use and demographic, lifestyle and health-status predictors: findings from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heidelberg cohort. Br j Nutr 2010; 104 (07) 1058-1064
• 10 Skeie G, Braaten T, Hjartaaker A et al. Use of dietary supplements in the European Prospective Investigation into Cancer and Nutrition calibration study. EurJ Clin Nutr 2009; 63: 226-238
• 11 EPCEU – The European Parliament and the Council of the European Union . Directive 2002/46/EC of the European parliament and of the council of 10 June 2002 on the approximation of the laws of the Member States relating to food supplements. OJEC 2002; L183/51
• 12 NCCAM – National Center for Complementary and Alternative Medicine About dietary supplements. In: Using dietary supplements wisely. NCCAM Publication No. D426 2009 http://nccam.nih.gov/health/supplements/wiseuse.htm#about
• 13 Nahas R, Moher M. Complementary and alternative medicine for the treatment of type 2 diabetes. Can Fam Physician 2009; 55: 591-596
• 14 Gonzalez-Seijo JC, Ramos Y, Lastra I. Manic episode and ginseng: Report of a possible case. J Clin Psychopharmacol 1995; 15 (06) 447-448
• 15 Borelli F, Izzo AI. Herb-Drug Interactions with St John’s Wort (Hypericum perforatum) an Update on Clinical Observations. The AAPS Journal 2009; 11 (04) 710-727
• 16 ATBC-STUDY GROUP 1994, Beta Carotene Cancer Prevention Study Group . The effect of Vitamin E and Beta Carotene on the Incidence of Lung Cancer and Other Cancers in Male Smokers. NEJM 1994; 330: 1029-1035
• 17 De Smet PAGM Health risks of herbal remedies: an update. Clin Pharmacol Ther 2004; 7 (01) 1-17
• 18 Ernst E. Serious adverse effects of unconventional therapies for children and aldolescents: a systematic review of recent evidence. Eur J Pediatr 2003; 162: 72-80
• 19 Oldham L, Kendall P, Cobb B et al. Perceptions of dietary supplements among older women with diabetes. Diabetes Educ 2004; 30: 658-664
• 20 Dulon M, Bardehle D, Blettner M. Assessing Social Inequality in Microcensus Data and German National Health Examination Survey. Gesundheitswesen 2003; 65: 629-635
• 21 Niv N, Shatkin JP, Hamilton AB et al. The use of herbal medications and dietary supplements by people with mental illness. Community Ment Health J 2009; 46 (06) 563-569
• 22 Tanaka MJ, Gryzlaj BM, Zimmermann MB et al. Patterns of natural herb use by Asian and Pacific Islanders. Ethn Health 2008; 13 (02) 93-108
• 23 Liang W, Lee AH, Binns CW. Dietary supplementation by older adults in southern China: a hospital outpatient clinic study. BMC Complement Altern Med 2009; 9: 39
• 24 Chang H, Wallis M, Tiralongo E. Use of complementary and alternative medicine among people with type 2 diabetes in Taiwan: A cross-sectional survey. Evid Based Complement Alternat Med 2011; pii 983792. [Epub 2010 Sep 8]
• 25 Ock SM, Hwang SS, Lee JS et al. Dietary supplement use by South Korean adults: Data from the national complementary and alternative medicine use survey (NCAMUS) in 2006. Nutrition Research and Practice 2010; 4 (01) 69-74
• 26 Song Y, Xu Q, Park Y et al. Multivitamins, individual vitamin and minerals supplements, and risk of diabetes mellitus among older U.S. adult. Diab Care 2010; 34 (01) 108-114
• 27 Brzozowska A, Enzi G, Amorin Cruz J. Medicine use and supplementation practice among participants of SENECA Study. J Nutr Health Aging 2002; 6 (01) 34-38
• 28 Ryan EA, Pick ME, Marceau C. Use of alternative medicine in diabetes mellitus. Diab Med 2001; 18: 242-245
• 29 Marchioli R, Schweiger C, Tavazzi L et al. Efficacy of n-3 polyunsaturated fatty acids after myocardial infarction: results of GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico. Lipids 2001; Suppl 36: S119-S126
• 30 Greenlee H, Kwan LE, Ergas IJ et al. Complementary and alternative therapy use before and after breast cancer diagnosis: the Pathways Study. Breast Cancer Res Treat 2009; 117 (03) 653-665
• 31 Mang B, Wolters M, Schmitt B et al. Effects of cinnamon extract on plasma glucose, HbA, and serum lipids in diabetes mellitus type 2. Eur J Clin Invest 2006; 36 (05) 340-344
• 32 Akilen R, Tsiami A, Devendra D et al. Glycated haemoglobin and blood pressure-lowering effect of cinnamon in multiethnic Type 2 diabetic patients in the UK: a randomized, placebo-controlled, double-blind clinical trial. Diab Med 2010; 27: 1159-1167
• 33 Fabian E, Töscher S, Elmadfa I et al. Use of Complementary and Alternative Medicine Supplements in Patients with Diabetes Mellitus. Ann Nutr Metab 2011; 58 (02) 101-108
• 34 RKI- Robert-Koch-Institut; Statistisches Bundesamt Hrsg Gesundheit in Deutschland- Gesundheitsberichterstattung des Bundes. Berlin: Robert-Koch-Institut; Juli 2006: 17-18
• 35 Dannemann K, Hecker W, Haberland H et al. Use of complementary and alternative medicine in children with type 1 diabetes mellitus- prevalence, pattern of use, and costs. Pediatr Diabetes 2008; 9 (3pt1) 228-235
• 36 Reinert A, Rohrmann S, Becker N et al. Lifestyle and diet in people using dietary supplements: a German cohort study. Eur J Nutr 2007; 46 (03) 165-173
• 37 Knudsen VK, Rasmussen LB, Haraldsdottir J et al. Use of dietary supplements in Denmark is associated with health and former smoking. Public Health Nutr 2002; 5 (03) 463-468
• 38 Skeie G, Hjartaker A, Lund E. Diet among breast cancer survivors and healthy women. The Norwegian Women and Cancer Study. Eur J Clin Nutr 2006; 60 (09) 1046-1054
• 39 Cott JM. Herb-drug interactions: focus on pharmacokinetics. CNS Spectr 2001; 6 (10) 827-832
• 40 Sobieraj DM, Freyer CW. Probable hypoglycaemic adverse drug reaction associated with prickly pear cactus, glipizide, and metformin in a patient with type 2 diabetes mellitus. Ann Pharmacother 2010; 44 (7/8) 1334-1337
• 41 Bjelakovic G, Nikolova D, Gluud LL et al. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematc review and meta-analysis. JAMA 2007; 297 (08) 842-857
• 42 Brzozowska A, Kaluza J, Knoops KTB et al. . Supplement use and mortality: the SENECA study. Eur J Nutr 2008; 47: 131-137