Complementary and alternative medicine (CAM) use and its disclosure to providers among ethnically diverse safety net patients with diabetes in san francisco

Background: Explicit knowledge of CAM use can help clinicians and patients make informed treatment plans. However, CAM use among patients with chronic illnesses is poorly understood, as is the extent to which CAM use is self-disclosed to providers. Objective: To report the prevalence of CAM use and disclosure to providers among ethnically diverse safety-net patients with diabetes enrolled in a diabetes self-management support program. Methods: Within a Medicaid managed care program providing language-concordant health coaching to patients with poorly controlled diabetes, the San Francisco Health Plan's Smart Steps Program enrolled 362 participants between 2009-2011. Six and twelve month telephone interviews collected self-reported CAM use in the preceding 30 days, based on a 12-domain validated instrument in English, Spanish and Cantonese. Results: Seventy-seven percent (n=278) of participants completed follow-up interviews including demographics and CAM use. Participants were predominantly Asian (60.1%) or Latino (22.6%), female (74.1%), and non-English-speaking (71.9%). Mean age was 55 years, with a mean of 7.0 years with diabetes. Any CAM use was reported by 51.4% of participants. Specific modalities included: vitamins/nutritional supplements (25.9%), natural remedies/herbs (24.5%), massage/acupressure (11.5%), and meditation/yoga/tai chi (10.4%) at a median monthly cost of $33 (range 0-$1200). Nearly a third (30.0%) used CAM specifically for diabetes; 47.2% did not disclose CAM use to a clinician, for reasons including ‘no one asked' and ‘didn't think they needed to know'. Conclusions: CAM use is common among this diverse safety net population, for general health and for diabetes, but disclosure to clinicians is incomplete. Barriers to disclosure should be explored to improve health communication around diabetes care.