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Lifestyle counseling accelerated achievement of treatment goals for patients with diabetes
Morrison F. Diabetes Care. 2012;35:334-341.
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Lifestyle counseling as part of primary care helped those with diabetes achieve and maintain control of HbA1c, blood pressure and LDL cholesterol levels faster, results from a recent study show.
Researchers at Brigham and Women’s Hospital in Boston conducted a retrospective cohort study of more than 30,000 patients with diabetes who received diet, exercise and weight-loss counseling in a primary care setting for at least 2 years from 2000 to 2010. Average follow-up was 7 years, and treatment targets were HbA1c lower than 7%, BP lower than 130 mm Hg/85 mm Hg and LDL lower than 100 mg/dL. Patients were aged 18 years or older; had a documented diagnosis of diabetes or an HbA1c of 7% or higher; and at least one instance of HbA1c, BP or LDL above treatment goals.
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According to study data, more frequent face-to-face lifestyle counseling resulted in more rapid achievement of treatment targets. Patients who underwent counseling at least once per month reached an HbA1c of lower than 7% after a median of 3.5 months vs. 22.7 months for those who received counseling less than once per 6 months (P<.0001). Similarly, median time to achieving a BP lower than 130 mm Hg/85 mm Hg was 3.7 weeks for patients who received more frequent counseling compared with 5.6 months for those who received less frequent counseling (P<.0001). Median time to attaining target LDL levels was also lower for the group receiving more frequent counseling (3.5 months vs. 24.7 months; P<.0001).
Further, a multivariable analysis associated one additional monthly face-to-face lifestyle counseling episode with HRs of 1.7 for HbA1c control (P<.0001); 1.3 for BP control (P<.0001); and 1.4 for LDL control (P=.0013), the researchers wrote.
“The main take-home message [of this study] is that it provides evidence that lifestyle counseling can be effective not only in clinical trial settings where patients may be more motivated and more extensive resources are available, but also in everyday medical practice that is at the frontlines of battling diabetes,” study researcher Alexander Turchin, MD, MS, of Brigham and Women’s Hospital in Boston, told Endocrine Today.
Disclosure: The researchers report no relevant financial disclosures.
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This study attempts to answer an important question about the efficacy of real world lifestyle counseling in primary care practice. This is an important issue, as the perceived challenges of intensive lifestyle counseling as performed in most clinical trials is likely to discourage many providers from feeling they can implement these efficacious strategies into their practice. This study suggests that increased frequency of lifestyle counseling does have an impact in the time it takes to achieve treatment goals, although the effect size is relatively small when corrected for other factors. Not surprisingly, the frequency of visits with the PCP, the frequency of testing the parameter under consideration and the frequency of medication adjustment had much larger effects. The encouraging thing about this study is that it suggests that even as little as a mention about the patient's weight and the need to improve lifestyle may have a detectable effect over time on reaching treatment goals.
– Dawn Belt Davis, MD, PhD
Endocrine
Today Editorial Board member
Disclosure: Dr. Davis reports no relevant financial disclosures.
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