Use of Complementary Health Approaches Among Diverse Primary Care Patients with Type 2 Diabetes and Association with Cardiometabolic Outcomes: From the SF Bay Collaborative Research Network (SF Bay CRN)
Journal of the American Board of Family Medicine
and Dean Schillinger, MD Purpose: To describe use of complementary health approaches (CHAs) among patients with type 2 diabetes, and independent associations between CHA use and Hemoglobin A1c (A1C) and lower-density lipoprotein (LDL) cholesterol. Methods: Participants were enrolled onto the SMARTSteps Program, a diabetes self-management support program conducted between 2009 and 2013 in San Francisco. At the 6-month interview, CHA use in the prior 30 days was estimated using a 12-item
... a 12-item validated instrument. Demographic and diabetes-related measures A1C were assessed at baseline and 6-month followup. AIC and LDL values were ascertained from chart review over the study period. Medication adherence was measured using pharmacy claims data at 6 and 12 months. Results: Patients (n ؍ 278) completed 6-month interviews: 74% were women and 71.9% were non-English speaking. Any CHA use was reported by 51.4% overall. CHA modalities included vitamins/nutritional supplements (25.9%), spirituality/prayer (21.2%), natural remedies/herbs (24.5%), massage/ acupressure (11.5%), and meditation/yoga/tai chi (10.4%). CHA costs per month were $43.86 (SD ؍ 118.08). Nearly one third reported CHA (30.0%) specifically for their type 2 diabetes. In regression models, elevated A1C (>8.0%) was not significantly associated with overall CHA use (odds ratio [OR] ؍ 1.78; 95% confidence interval [CI], 0.7 to 4.52) whereas elevated LDL was (OR ؍ 3.93; 95% CI, 1.57 to 9.81). With medication adherence added in exploratory analysis, these findings were not significant. Conclusions: CHA use is common among patients with type 2 diabetes and may be associated with poor cardiometabolic control and medication adherence. (J Am Board Fam Med 2017;30:624 -631.) Background The use of complementary health approaches (CHA), defined as "health care practices outside of the mainstream, used to complement or supplant conventional medical care," 1 has grown rapidly. 2-4 CHA encompass a wide range of cultural and spiritual interventions, products, and disciplines including herbal and dietary supplements; yoga; spir-This article was externally peer reviewed.