Tailored therapy useful for overcoming barriers to lifestyle modification

American College of Cardiology 60th Annual Scientific Sessions

NEW ORLEANS - As the number of people with type 2 diabetes and cardiovascular complications continues to grow, so do the medical costs associated with the disease. By encouraging patients to make lifestyle modifications, health care providers may be able to help alleviate some of this financial burden, according to a speaker here.

A variety of data demonstrate significant benefits of lifestyle change in patients with diabetes, Cindy Lamendola, MSN, ANP-BC, of Stanford University, said during a presentation. Specifically, she cited a crossover dietary trial, recently published in Diabetes Care, that compared the DASH diet with a typical diet in patients with type 2 diabetes. The DASH diet had an increased amount of fiber, whole grains, fruits and vegetables consumed daily, and participants met monthly with dietitians. Results revealed that patients on the DASH diet experienced considerable improvements in many areas, including HbA1c, systolic and diastolic blood pressure, LDL and HDL levels when on the DASH diet when compared with a typical diet.

Lamendola also highlighted results from another trial of an intervention given in the hospital after an acute coronary syndrome (ACS), including dietary advice, smoking cessation and 30 minutes of exercise three times per week. Data showed that, compared with nonadherers, adherers to both diet and exercise (29%) and no smoking had a 50% lower risk for a major event compared with nonadherers in the 6 months after an ACS. However, the study also indicated that patients were more likely to a medication regimen than the intervention.

Individualized therapy

Lamendola explained that addressing the intervention from different angles tailored to individual patients may mitigate this problem.

"Health care providers should use different combinations [of lifestyle modification] to be successful in the clinic and beyond," she said. "They need to expand the roles of their professional staff, have educational materials available and understand the need for cultural sensitivity. We also need to use outside resources, such as cardiac rehabilitation programs, Weight Watchers and YMCA."

She said certain strategies are important to keep patients motivated. Research indicates that setting realistic, short-term goals produced better results, as did group sessions and the use of monitoring tools that utilize feedback and follow-up.

Barriers to implementation

Lamendola noted, however, that health care providers may face barriers to implementing lifestyle modification programs in their practices. For instance, many believe they have insufficient information or skills to properly introduce lifestyle modification to patients. Another major issue is limited resources.

"The American College of Cardiology, the American Heart Association and the Preventive Cardiovascular Nurses Association offer information on lifestyle counseling, and the National Heart, Lung and Blood Institute are working on guidelines [addressing lifestyle modifications] that will be released in 2013," Lamendola said. "The health care system also needs to support preventive interventions."

Financial issues may be difficult to overcome, but Lamendola explained that her institution has found unique ways to address the issue; for example, having a clinical nurse specialist who is also a diabetes educator and offers classes to patients to supplement the education that they already received. In addition, frequent office visits, novel methods of communication and referring patients to outside sources, such as cardiology rehabilitation centers, may also be beneficial for health care providers who have limited resources. - by Melissa Foster

Disclosure: Lamendola reports no relevant financial disclosures.

For more information:

• Lamendola C. ACC Symposium 06225-5. Presented at: ACC 60th Annual Scientific Sessions; April 2-5, 2011; New Orleans.

Lifestyle modification is the foundation of our therapy for patients with diabetes. There are profound data on this. The problem is that it is the most difficult thing to maintain and motivate our patients to do. I was particularly intrigued and in agreement with Lamendola’s thoughts about how to motivate patients and how to get patients engaged. I believe that short-term, achievable goals are really important. In addition, utilizing contracts in the office — in which a patient actually signs a document saying that they agree to work on their level of exercise — gives patients some accountability and engages them in their own health care. If we don’t get the buy-in of the patients, then we can’t possibly be successful.

– Rhonda Cooper-DeHoff, PharmD

Associate Professor, Department of Pharmacotherapy and Translational Research
Colleges of Pharmacy and Medicine, University of Florida

Disclosure: Dr. Cooper-DeHoff reports no relevant financial disclosures.

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