Comparison of Patients’ Perceptions of Safety and Efficacy of Herbal and Conventional Type 2 Diabetes Treatments in Nairobi, Kenya

Abstract

Background: Use of herbal medicines is common among patients with type 2 diabetes in Kenya. Studies on patient-reported efficacy and safety of these medicines are lacking. Aims: To determine and compare satisfaction with safety and efficacy of medicines among patients with type 2 diabetes on herbal and conventional glucose-lowering agents. Study Design: A descriptive cross-sectional study design was used. Place and Duration of Study: Outpatient diabetes clinics at Kenyatta National Hospital and New Life Herbal Clinic in Nairobi, Kenya. The study was carried out between March 2019 and December 2021. Methodology: We recruited 80 patients with type 2 diabetes on conventional glucose lowering agents at Kenyatta National Hospital and 37 patients on herbal antidiabetic therapies at New Life Herbal Clinic.  A general questionnaire was used to collect data on sociodemographic and clinical characteristics of the participants. Treatment Satisfaction with Medicines Questionnaire was used to assess patient satisfaction with medicines. The Chi-square test was performed to compare the proportions of responses in the two groups. Mann -Whitney U test was used to compare the domain scores at the two study sites.  Linear regression analysis was used to identify the determinants of satisfaction with side effects and efficacy of antidiabetic treatments. Results: The median score on the side effects domain in patients on herbal medicines was 100 [70.83-100] compared to 20.83[0-66.67] among those treated at Kenyatta National Hospital (p<0.001). Patients treated with conventional medicines had higher scores on the efficacy of medicines domain (100 [83.33-100]) compared to 75 [70.83-100] at the herbal clinic(p=0.006). Treatment at the herbal clinic was associated with significant improvement in satisfaction with side effects of medications (3.144 scores (95% CI=2.534, 3.755, p<0.001). Other significant determinants of  satisfaction with side effects were   distance from healthcare facility (0.518 scores (95% CI=0.065, 0.970), p=0.025), experiencing tingling sensations (-2.251 scores (95% CI=-3.348, -1.154, p=<0.001), infrequent HbA1c monitoring  (-0.877 scores (95% CI=-1.402, -0.352), p=0.001),  sweating (1.278 scores (95% CI=0.527, 2.029, p<0.001) , numbness (1.045 scores  (95% CI=0.285, 1.805, p=0.007). Treatment with inhaled corticosteroids reduced satisfaction in the side effects domain by -1.609 scores (95% CI= -2.750,-0.468, p=0.006). Significant reductions in satisfaction with efficacy of medications scores was associated with presence of comorbidities (-2.559  scores (95% CI=-3.382- -1.736), p<0.001), treatment with Prunus africana (-1.433 scores ,95% CI=-2.246- -0.620, p<0.001), concurrent use of herbal and conventional glucose-lowering agents (-0.418 scores, (95% CI=-0.783- -0.052), p=0.025) and use of Apium graveolens ( -0.878 scores, (95% CI=-1.589- ,-0.168)), p=0.015). Conclusion: The study findings highlight significant differences in patients’ perception of safety and efficacy of herbal and conventional type 2 diabetes treatments. Treatment at the herbal clinic, accessibility to healthcare and patient symptoms were significant determinants of patient satisfaction with side effects of medications.  Presence of comorbidities and treatment with herbal drugs led to a decline in patients’ perception of efficacy of their antidiabetic treatments.