Noura A. Abouammoh

1.2.3 Alternative medicine

The use of alternative medicine is common among Saudi people (Al-Faris et al., 2008). Alternative medicine using cumin, honey and black seeds was acknowledged more than 1400 years as its use was mentioned in the Prophet Mohammad’s teachings. Saudi people refer to this type of medicine as “Prophetic medicine”.

Alternative medicine in Islam includes practices such as cauterization, cupping, reading the Quraan and repeating certain sayings pointing at a painful area. All these practices are commonly used by Saudi people (Al-Rowais et al., 2010).

Although alternative medicine may include the use of herbal medicine, the term “herbal medicine” is used among Saudi people to refer to herbs and spices that are used as medicine, yet were not specifically recommended by Islamic teachings. For example, myrrh, helteet (Asafoetida) and fenugreek are some of the herbs used specifically by Saudi patients with diabetes (Al-Rowais, 2002).

Saudi people strongly believe in alternative medicine, in general, probably because it is recommended in Islam; however, unhealthy practices in this regard are not uncommon. For example, a study showed that Saudi patients may abstain from using prescribed medical treatment when they use herbs to treat chronic disease such as T2DM (Al-Rowais, 2002).

In SA, “Attar” shops, which sell a huge variety of herbs, are found in abundance and the sellers are usually older, traditional Saudis who pass their experience on to their children and are consulted by the consumers regarding herbal remedies for certain health conditions. Seventy-three percent of the 296 patients who were included in a study to determine the prevalence of herbal medicine use among patients with diabetes, did not inform their physicians in regard to using herbal remedies to treat diabetes in SA (Al-Rowais, 2002). Patients’ reasons for not informing their physicians included the fact that doctors did not ask questions that related to the use of herbs, they did not think it was important for doctors to know, or they feared that the doctor would ask them to discontinue taking it (Al-Rowais, 2002).

Due to the extensive use of alternative medicine, the Saudi Council of Ministers issued a resolution in 2008 for the National Center for Complementary and Alternative Medicine to be created as a pioneer in regulating and controlling practices of complementary and alternative medicine under the Ministry of Health (MOH). In 2013 the Health Minister announced that the need to support alternative medicine with scientific experience had become urgent due to the recognition of the growing use of alternative medicine and regulate the use of this kind of medicine as it may affect patients’ consumption of prescribed medication.

In general, the previously identified genetic predisposition to developing diabetes among the Saudi population, which is complicated by the tradition of consanguineous marriages (El-Hazmi et al., 1995) that contribute in increasing the risk of developing T2DM (Anokute, 1992, Bener et al., 2005) and the high obesity rate that resulted from the above mentioned unhealthy lifestyle, have led to the increased prevalence of T2DM in the country (Elhadd et al., 2006).

1.3 Diabetes and its management

Diabetes is a major public health concern across the world. It has devastating complications and implications in terms of patients’ health (Weinger and Leighton, 2009). Globally, the estimated number of people with diabetes is 285 million in 2010, and it is expected that it will affect 366 million people by the year 2030 (Wild et al., 2004).

1.3.1 Type 2 diabetes

Diabetes represents a group of metabolic defects characterized by increasing blood glucose concentration (hyperglycaemia) resulting from a decrease in insulin secretion, action or both (insulin is the key hormone controlling glucose flow in and out of the body cells) (Watkins, 2003). Type 1 diabetes mellitus (T1DM) is the most common type affecting children and young people. It is also known as insulin dependent diabetes mellitus (IDDM) because patients mainly rely on insulin to control their condition. Type 2 diabetes mellitus is the most common type affecting adults. This type was previously known as non-insulin dependent diabetes mellitus (NIDDM), as giving insulin is not the first or only solution to control the condition. Furthermore, lifestyle behaviours such as unhealthy eating habits and adopting sedentary lifestyle are key factors for developing T2DM. The table below summarizes the main differences and characteristics of T1DM and T2DM.
Table 1.1 Different characteristics of type 1 and type 2 diabetes mellitus
(Watkins, 2003)

Type 1	Type 2
Cause
Loss of insulin production	Decrease insulin secretion, increase insulin resistance, or both
Incidence
Peak incidence at 10-12 years of age. 70% of the cases occur <40 years of age. Has slightly male predominance	Most commonly affects people between the ages of 50 – 70 years. Children from certain ethnic groups might present with T2DM, especially if combined with obesity. Equally effecting males and females
Risk factors
Genetic Environmental Autoimmune destruction of the pancreas	Obesity. Age of more than 40 years. Certain ethnic groups (Afro-Caribbean, Asian, Hispanic). Family history of diabetes. History of gestational diabetes
Treatment
Insulin in conjunction with diet and exercise	In sequential order: Diet and exercise Oral hypoglycaemic agents