Integrative and complementary practices in diabetes management: a rapid review of clinical guidelines

To map clinical guidelines that used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to make recommendations on integrative and complementary health practices (ICHP) in diabetes management.

The search was conducted in Medline/PubMed, Embase, and Scopus on 24 October 2024, with no date limits. Guidelines that applied the GRADE system were included. Title and abstract screening was duplicated and performed independently. One reviewer conducted full-text reading and data extraction, and another performed verification. Methodological quality was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, specifically the rigor of the development domain. A narrative synthesis was organized by outcome.

Of the seven guidelines included, five showed high methodological confidence, one moderate, and one low. Recommendations were favorable for psychological support, self-care education, foot- and ankle-focused exercises, low-impact exercises, mindfulness, Ayurveda, and essential oils as additional supports; they were unfavorable for apitherapy and ozone therapy. Heterogeneity in outcomes and variation in the consistency of recommendations were observed.

There are insufficient guidelines on ICHP in diabetes management, with methodological variability and inconsistent recommendations. New guidelines, with greater rigor and transparency, may support decision-making regarding the incorporation of ICHP into the Brazilian Unified Health System (Sistema Único de Saúde, SUS). Among the practices assessed, exercise, mindfulness, and self-care showed stronger evidence and may be prioritized in primary care for diabetes management.