Lifestyle Counseling in Routine Care and Long-Term Glucose, Blood Pressure, and Cholesterol Control in Patients With Diabetes

Abstract

OBJECTIVEIn clinical trials, diet, exercise, and weight counseling led to short-term improvements in blood glucose, blood pressure, and cholesterol levels in patients with diabetes. However, little is known about the long-term effects of lifestyle counseling on patients with diabetes in routine clinical settings.RESEARCH DESIGN AND METHODSThis retrospective cohort study of 30,897 patients with diabetes aimed to determine whether lifestyle counseling is associated with time to A1C, blood pressure, and LDL cholesterol control in patients with diabetes. Patients were included if they had at least 2 years of follow-up with primary care practices affiliated with two teaching hospitals in eastern Massachusetts between 1 January 2000 and 1 January 2010.RESULTSComparing patients with face-to-face counseling rates of once or more per month versus less than once per 6 months, median time to A1C <7.0% was 3.5 versus 22.7 months, time to blood pressure <130/85 mmHg was 3.7 weeks versus 5.6 months, and time to LDL cholesterol <100 mg/dL was 3.5 versus 24.7 months, respectively (P < 0.0001 for all). In multivariable analysis, one additional monthly face-to-face lifestyle counseling episode was associated with hazard ratios of 1.7 for A1C control (P < 0.0001), 1.3 for blood pressure control (P < 0.0001), and 1.4 for LDL cholesterol control (P = 0.0013).CONCLUSIONS Lifestyle counseling in the primary care setting is strongly associated with faster achievement of A1C, blood pressure, and LDL cholesterol control. These results confirm that the findings of controlled clinical trials are applicable to the routine care setting and provide evidence to support current treatment guidelines.

Automating Assessment of Lifestyle Counseling in Electronic Health Records

“…For example, an evaluation of primary care records for 30,000 patients with diabetes showed that lifestyle counseling (identified using NLP) was strongly associated with faster achievement of A1C, blood pressure, and LDL cholesterol control. 21 …”

Psychometric Properties of the Swedish Version of the Fear of Complications Questionnaire

“…Recently, a multinational study showed that it is important to capture an individual's barriers for achieving optimal diabetes self-care in order to attain a good glucose level and enhance quality of life (QoL) [2]. Maintaining a good glucose control level is a major task among persons with diabetes [3] and is a balancing act [4] in relation to the individual's QoL [5]. Failure to maintain a good glucose control level puts the person at risk of developing future diabetes-related microvascular complications (e.g., neuropathy, retinopathy and nephropathy) and macrovascular complications (e.g., cardiovascular disease and stroke) [6] [7].…”

The impact of lifestyle medicine continuing education on provider knowledge, attitudes, and counseling behaviors

“…Lifestyle medicine also supports patient-centered care, and aims to make patients more knowledgeable and motivated as well as more competent in managing their own health (Egger et al 2008). When physicians and other health care providers incorporate lifestyle medicine into their practices, patient outcomes have improved (Orchard et al 2005;Dod et al 2010;Sweet & Fortier 2010;Cox et al 2011;Morrison et al 2012).…”