Quantity and Quality of Complementary and Alternative Medicine Recommendations in Clinical Practice Guidelines for Type 2 Diabetes Mellitus: A Systematic Review

Abstract Aims Approximately 70% of Americans with diabetes have used complementary and alternative medicine (CAM) in the past year. Healthcare providers often receive minimal training on these therapies and consequently rely on clinical practice guidelines (CPGs) to supplement their knowledge about the safe and effective use of CAM for the treatment/management of type 2 diabetes mellitus (T2DM). The purpose of this systematic review is to determine the quantity and assess the quality of CAM recommendations in CPGs for the treatment and/or management of T2DM. Data Synthesis MEDLINE, EMBASE, and CINAHL were systematically searched from 2009 to 2020, in addition to the Guidelines International Network and the National Center for Complementary and Integrative Health websites. CPGs containing treatment and/or management recommendations for T2DM were eligible; those with CAM recommendations were quality-assessed with the AGREE II instrument twice, once for the overall CPG and once for the CAM sections. Twenty-seven CPGs were deemed eligible, of which 7 made CAM recommendations. Mean scaled domain percentages were (overall, CAM): scope and purpose (89.68%, 79.76%), clarity of presentation (85.71%, 48.41%), stakeholder involvement (67.86%, 28.17%), applicability (54.76%, 20.24%), rigour of development (49.7%, 35.71%), and editorial independence (44.05%, 44.05%). Conclusions Quality varied within and across CPGs; domain scores across CAM sections generally scored lower than the overall CPG. Given that CAM therapies for T2DM are only represented in one-quarter of eligible CPGs and are of lower quality, a knowledge gap for healthcare providers who seek evidence-based information on this topic in order to effectively counsel inquiring patients.