MON-670 - Association of Complementary and Integrative Health Utilization with Glycemic Control Among Veterans with Diabetes

Background:
Complementary and integrative health (CIH)/ Whole Health (WH) therapies in the Veterans Administration (VA) are often used for symptom-focused conditions such as pain, stress, and post-traumatic stress disorder. WH emphasizes patient-centered care by aligning health plans with personal values and life goals to promote overall well-being rather than symptom-focused management. Their role in chronic disease management, including diabetes, is less well characterized. Given the high burden of diabetes among Veterans, evaluating CIH/WH in relation to glycemic control is essential.

Objective:
To evaluate demographic characteristics, utilization trends, and the association between CIH/WH visits and change in hemoglobin A1c (HbA1c) among Veterans with diabetes receiving care in the VA.

Methods:
We conducted a retrospective cohort study of 25,579 Veterans with diabetes between 2015 and 2024. CIH/WH utilization was defined as at least one documented visit. We used a mixed effects model to assess the association between the number of CIH/WH visits (none, 1–2 visits, >2 visits) and change in HbA1c, adjusting for sociodemographic and clinical covariates.

Results:
Among the cohort, 13,273 Veterans (52%) utilized CIH/WH services. Compared with non-users, CIH/WH users were younger (mean age 69.6 vs 74.5 years, p< 0.01), more likely to be female, and less likely to identify as White. CIH/WH utilization increased over time. The most common CIH/WH visits were WH activities (51%), WH clinical care (48%), WH coaching (19%), chiropractic care (14%), acupuncture (13%), meditation (10%), massage therapy (8%), and battlefield acupuncture (8%); visit categories were not mutually exclusive. In adjusted analyses, Veterans with 1–2 CIH/WH visits experienced a modest reduction in HbA1c (β −0.04, p=0.05), while those with more than two CIH/WH visits demonstrated a greater reduction in HbA1c (β −0.28, p< 0.0001) compared with Veterans with no CIH/WH visits, indicating a dose–response relationship.

Conclusions:
CIH/WH utilization was associated with statistically significant improvements in glycemic control in a large, diverse Veteran population, with evidence of a dose–response relationship. Our findings suggest CIH/WH may serve as a valuable adjunct to conventional diabetes care. Prospective studies are warranted to clarify mechanisms and optimize integration of CIH/WH into diabetes management.

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