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Research ArticleOriginal Research

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)

Margaret A. Handley, Judy Quan, Maria T. Chao, Neda Ratanawongsa, Urmimala Sarkar, Sophia Emmons-Bell and Dean Schillinger
The Journal of the American Board of Family Medicine September 2017, 30 (5) 624-631; DOI: https://doi.org/10.3122/jabfm.2017.05.170030
Margaret A. Handley
From General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco Zuckerberg General Hospital and Trauma Center, University of California, San Francisco, CA (MAH, JQ, MTC, NR, US, DS); the Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California, San Francisco (MAH, SE); and Osher Center for Integrative Medicine, University of California, San Francisco (MTC).
PhD, MPH
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Judy Quan
From General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco Zuckerberg General Hospital and Trauma Center, University of California, San Francisco, CA (MAH, JQ, MTC, NR, US, DS); the Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California, San Francisco (MAH, SE); and Osher Center for Integrative Medicine, University of California, San Francisco (MTC).
PhD
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Maria T. Chao
From General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco Zuckerberg General Hospital and Trauma Center, University of California, San Francisco, CA (MAH, JQ, MTC, NR, US, DS); the Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California, San Francisco (MAH, SE); and Osher Center for Integrative Medicine, University of California, San Francisco (MTC).
DrPH
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Neda Ratanawongsa
From General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco Zuckerberg General Hospital and Trauma Center, University of California, San Francisco, CA (MAH, JQ, MTC, NR, US, DS); the Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California, San Francisco (MAH, SE); and Osher Center for Integrative Medicine, University of California, San Francisco (MTC).
MD, MPH
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Urmimala Sarkar
From General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco Zuckerberg General Hospital and Trauma Center, University of California, San Francisco, CA (MAH, JQ, MTC, NR, US, DS); the Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California, San Francisco (MAH, SE); and Osher Center for Integrative Medicine, University of California, San Francisco (MTC).
MD, MPH
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Sophia Emmons-Bell
From General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco Zuckerberg General Hospital and Trauma Center, University of California, San Francisco, CA (MAH, JQ, MTC, NR, US, DS); the Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California, San Francisco (MAH, SE); and Osher Center for Integrative Medicine, University of California, San Francisco (MTC).
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Dean Schillinger
From General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco Zuckerberg General Hospital and Trauma Center, University of California, San Francisco, CA (MAH, JQ, MTC, NR, US, DS); the Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California, San Francisco (MAH, SE); and Osher Center for Integrative Medicine, University of California, San Francisco (MTC).
MD
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Article Figures & Data

Tables

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    Table 1.

    Socio-Demographic and Health Characteristics of SMARTSteps Participants by Reported Use of Complementary Health Approaches (CHA) N = 278

    Sociodemographic CharacteristicsCHA Use Reported, n, % (N = 143)§No CHA Use Reported, n, % (N = 135)P-Value
    Age, years (SD)55.4 (9.3)55.9 (7.5).90
    Women77.6%70.4%.17
    Race/ethnicity
        Latino29.4%15.6%.01
        Black/African-American11.2%5.9%
        Asian/Pacific Islander51.0%69.6%
        White/Caucasian7.0%6.7%
        Multi-ethnic/other1.4%2.2%
    Born outside the United States80.2%91.3%.01
    Language
        Cantonese speaking42.0%63.7%.001
        Spanish speaking24.5%14.1%
        English peaking33.6%22.2%
    Educational attainment
        Some high school or less48.4%57.1%.09
        High school graduate or GED20.6%23.0%
        Some college, college graduate, or above31.0%19.8%
    Employment status
        Employed full time24.6%18.3%.80
        Part time46.8%49.2%
        Unemployed10.3%11.1%
        Disabled7.1%8.7%
        Homemaker/Retired/Other11.1%12.7%
    Annual household income <$20,00065.3%61.3%.55
    Insurance type
        Medicaid/MediCal18.2%23.1%.48
        Medicare7.0%3.7%
        Healthy worker/healthy SF74.1%71.6%
        Other0.7%1.5%
    Limited health literacy34.9%51.2%.009
    Diabetes-related clinical, medication
        Adherence and functional health indicators*
            Years with diabetes, mean (SD)7.2 (6.1)6.8 (5.2).99
            Hemoglobin A1c (A1C) > 8.0%33.8%16.2%.01
            Hemoglobin A1c (A1C), mean (SD)7.91 (1.7)7.41 (1.3).06
            Low density lipoprotein (LDL), mg/dL, mean (SD)100.9 (35.2)84.7 (28.8).02
            Non-adherence-oral diabetes medication†39.5%24.2%.03
            Non-adherence-cardiometabolic medication†39.6%22.5%.01
            Food insecurity‡9.5%5.6%.04
            SF-12 physical component, mean (SD)44.9 (9.8)47.9 (8.8).009
            SF-12 mental component, mean (SD)47.8 (11.6)52.2 (9.9).002
            Bed days in last month, mean (SD)1.9 (5.2)0.7 (3.4)<.000
            Insulin use19.6%15.6%.38
    • ↵* , Sample size: for A1C, n = 148; for LDL, n = 89.

    • ↵† Non-adherence was measured using the continuous medication gap and a 15-day to 6-monthnth gap in refilling specific prescriptions.

    • ↵‡ Replied “often” or “sometimes” to having put off paying for diabetes medicine so would have money for food in last 12 months.

    • ↵§ With spirituality, prayer, religion excluded, n = 133 CHA users.

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    Table 2.

    Any Use of Practitioner-Delivered, Herbal-Ingested Supplements, and Other Modalities Among CHA Users by Language (N = 143)*

    Spanish, n, % (N = 35)English, n, % (N = 48)Cantonese, n, % (N = 60)P-Value
    Practitioner Delivered
        Massage, acupressure, accupuncture (N = 34)13 (38.2)13 (38.2)8 (23.5).01
        Chiropractic (N = 9)3 (33.3)5 (55.6)1 (11.1).09
        Chinese medicine (N = 22)03 (13.6)19 (86.4).01
    Herbal-ingested supplements
        Teas and herbs† (N = 68)15 (22.1)24 (35.3)29 (42.7).16
        Vitamins and packaged herbal supplements‡ (N = 72)12 (16.7)28 (38.9)32 (44.4).06
        Homeopathic remedies (N = 5)05 (100)0NA
    Other CHA modalities
        Yoga, meditation, tai chi (N = 29)1 (3.5)14 (48.3)14 (48.3).01
        Spirituality, religion or prayer for health (N = 59)§26 (44.1)30 (50.9)3 (5.1).1
        Other (N = 7)1 (14.3)5 (71.4)1 (14.3).03
    • ↵* Excluding types with less than 5 observations.

    • ↵† Exclusive use noted among 13 (19.1%) of users of teas and herbs (N = 9 Cantonese, and n = 2 each English and Spanish speakers).

    • ↵‡ Exclusive use noted among 20 (27.8%) of users of vitamins and packaged herbal supplements (N = 14 Cantonese, n = 5 English, and n = 1 Spanish speakers).

    • ↵§ Exclusive use noted among 10 (17.0%) of users of spirituality, prayer or religion (N = 7 Spanish and n = 3 English speakers).

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The Journal of the American Board of Family     Medicine: 30 (5)
The Journal of the American Board of Family Medicine
Vol. 30, Issue 5
September-October 2017
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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)
Margaret A. Handley, Judy Quan, Maria T. Chao, Neda Ratanawongsa, Urmimala Sarkar, Sophia Emmons-Bell, Dean Schillinger
The Journal of the American Board of Family Medicine Sep 2017, 30 (5) 624-631; DOI: 10.3122/jabfm.2017.05.170030

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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)
Margaret A. Handley, Judy Quan, Maria T. Chao, Neda Ratanawongsa, Urmimala Sarkar, Sophia Emmons-Bell, Dean Schillinger
The Journal of the American Board of Family Medicine Sep 2017, 30 (5) 624-631; DOI: 10.3122/jabfm.2017.05.170030
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Keywords

  • Cardiovascular Disease
  • Complementary Health Approaches
  • Health Communication
  • Health Disparities
  • Medication Adherence
  • Type 2 Diabetes

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