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)

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 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.