Older adults with diabetes are at high risk for having multiple chronic conditions and diabetes complications and often take multiple medications concomitantly. Studies have shown that many Americans are using complementary and alternative medicine (CAM) to either improve or manage their health (1,2). Individuals have diverse purposes for using CAM, from treating specific conditions, such as back and neck pain (e.g., acupuncture and chiropractic), to improving general health and wellness (e.g., meditation and tai chi). Since relatively little is known about the prevalence and patterns of CAM use in older adults with diabetes, we investigated this topic to guide integrated, patient-centered health care use for this population.
We used data from the 2012 National Health Interview Survey (NHIS), which is an annual cross-sectional in-person interview survey demonstrating health care trends among noninstitutionalized civilians in the U.S. (3). The NHIS collects comprehensive CAM-related information every 5 years. The sample included adults aged 65 or older who reported having any type of diabetes (n = 1,475 unweighted). We estimated key selected characteristics (e.g., age, sex, and race/ethnicity) of older CAM users with diabetes. We calculated prevalence rates of past-year CAM use by type and reason for use (i.e., treatment only, wellness only, and both treatment and wellness) (1,2,4). We performed all analyses using Stata/SE version 13.1 (StataCorp, College Station, TX), accounting for the survey sampling design (e.g., unequal probability of selection, clustering, and stratification) (5). All research procedures performed in this study were in accordance with the ethical standards of the institutional review board at Yale School of Medicine (approval ID #2000021662).
In 2012, more than 2 million older adults with diabetes (25.0%) used some form of CAM in the past year. Among older CAM users with diabetes, the mean age was 72.4 years and 54.3% were female. Race/ethnicity consisted primarily of non-Hispanic whites (73.4%), non-Hispanic blacks (8.8%), and Hispanics (10.6%). Of this sample, over half (56.2%) had some college or higher education.
Table 1 presents the prevalence of CAM use by type and reason for use and lists the individual modalities under each class. The most commonly used classes of CAM were biologically based therapies (62.8%) and manipulative body therapies (36.8%). The most commonly used individual therapies were herbal therapies (62.8%), chiropractic (23.9%), massage (14.7%), acupuncture (10.2%), and yoga (5.2%). Significant prevalence differences by reason for use (for treatment, wellness, or both) were found for herbal therapies, chiropractic, and meditation.
Table 1.
Prevalence of past-year CAM use by reason in older adults with diabetes, 2012 NHIS
| Among CAM users with diabetes, CAM used for: | |||||
|---|---|---|---|---|---|
| Treatment only | Wellness only | Both treatment and wellness | Total | P value | |
| Alternative medical systems | 8.5 | 14.8 | 7.7 | 10.2 | 0.272 |
| Acupuncture | 6.0 | 5.6 | 3.6 | 4.5 | 0.733 |
| Ayurveda | 0.0 | 0.0 | 0.0 | 0.0 | — |
| Naturopathy | 0.0 | 0.3 | 1.4 | 0.8 | 0.290 |
| Homeopathy | 1.7 | 8.7 | 3.5 | 4.8 | 0.096 |
| Traditional healers | 0.8 | 1.0 | 0.0 | 0.5 | 0.278 |
| Biologically based therapies | 45.7 | 67.6 | 66.4 | 62.8 | 0.030 |
| Chelation | 0.0 | 0.0 | 0.0 | 0.0 | — |
| Herbal therapies | 45.7 | 67.6 | 66.4 | 62.8 | 0.030 |
| Manipulative body therapies | 53.3 | 27.2 | 36.9 | 36.8 | 0.015 |
| Chiropractic | 47.7 | 10.9 | 23.2 | 23.9 | <0.001 |
| Massage | 7.1 | 17.4 | 15.8 | 14.7 | 0.202 |
| Movement therapies | 0.0 | 1.2 | 0.4 | 0.6 | 0.558 |
| Mind-body therapies | 6.6 | 10.6 | 14.2 | 11.6 | 0.365 |
| Meditation | 0.5 | 2.5 | 5.0 | 3.3 | 0.046 |
| Yoga | 0.0 | 4.9 | 7.4 | 5.2 | 0.158 |
| Tai chi | 0.0 | 5.5 | 4.2 | 3.8 | 0.217 |
| Qi gong | 0.0 | 1.0 | 0.7 | 0.6 | 0.566 |
| Biofeedback | 1.2 | 1.4 | 0.2 | 0.8 | 0.419 |
| Othersa | 5.0 | 1.4 | 0.6 | 1.7 | 0.049 |
| Energy therapiesb | 0.3 | 0.4 | 1.6 | 1.0 | 0.185 |
| Sample size (n) | |||||
| Unweighted sample | 65 | 124 | 188 | 377 | |
| Weighted population | 383,840 | 653,279 | 975,717 | 2,012,836 | |
Data are percent unless otherwise indicated. P value compares proportion differences by reason for use, using weight-corrected Pearson χ2 statistic.
Includes guided imagery, progressive muscle relaxation, and hypnosis.
Includes energy healing and craniosacral therapies.
More than 25% of older adults with diabetes used some type of CAM in the past year, which is only slightly less than the prevalence rate among the general adult population with diabetes (2). Older CAM users with diabetes utilized diverse types of CAM, and some of these CAM types had different prevalence rates by reason for use. Clinicians should actively query older patients with diabetes about CAM use. This can potentially prevent harm (e.g., drug-herb interactions and herb-disease interactions). Furthermore, patients should be educated to proactively discuss their CAM use with their health care providers, so that patient-centered care can be provided to meet the needs of older adults with diabetes. There are several limitations in this study, which are mentioned elsewhere (1,2). Despite the limitations, our findings highlight that CAM is widely used in older adults with diabetes. Future research should address integrative and holistic approaches for self-management of diabetes in older adults.
Article Information
Acknowledgments. Publicly available data were obtained from the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC). Analyses, interpretation, and conclusions are solely those of the authors and do not necessarily reflect the views of the CDC’s Division of Health Interview Statistics or NCHS.
Funding. T.G.R. received funding support from the National Institutes of Health National Institute on Aging (grant T32AG019134). The funding agency had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Duality of Interest. No potential conflicts of interest relevant to this article were reported.
Author Contributions. T.G.R. conceived and designed the study, acquired the data, performed statistical analyses, and drafted the manuscript. All authors interpreted the data and participated in critical revision of the manuscript for important intellectual content. T.G.R. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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