Advice to Physicians: Advise Your Patients

Source: Tufts University
April 30, 2002 (Reviewed: April 6, 2004)

A report in Archives of Internal Medicine reminds physicians that they are the ones in the best position to help people with diabetes get, and stay, as healthy as possible. More consistent counseling, says the report, is needed to help patients manage the cardiovascular risk factors--hypertension, obesity, inactivity, and smoking--that accelerate the damage linked to diabetes.

An analysis of counseling practices

Researchers from the University of South Carolina analyzed Behavioral Risk Factor Surveillance System data on 9,496 adults with diabetes and 150,493 adults without the disease. Participants were categorized according to the presence of modifiable cardiovascular disease (CVD) risk factors--hypertension, high cholesterol, obesity, smoking, and sedentary lifestyle. Those who had visited a physician within the past year reported whether or not the doctor or another health care professional talked to them about weight loss, exercise, cutting back on foods high in fat and cholesterol, or smoking cessation.

Participants with diabetes were significantly more likely than those without diabetes to report hypertension (56% vs. 22%), high cholesterol (41% vs. 20%), physical inactivity (66% vs. 56%), and overweight and obesity (78% vs. 57%; all p<0.001). Because diabetes often occurs in the presence of other CVD risk factors, these patients would especially benefit from instructions on making some lifestyle changes. But, did they receive the guidance they needed?

Those patients with diabetes who reported having a physician check-up within the previous year were more likely than those without the disease to receive counseling from a health care professional on weight loss (50% vs. 21%), smoking cessation (78% vs. 67%), increasing physical activity (67% vs. 36%), and a low-fat diet (78% vs. 71%). These differences remained even after multiple regression adjusted for the effects of age, sex, ethnicity, education, and income.

The deadly quartet

The combination of hypertension, high cholesterol, and obesity in people with diabetes is referred to as the metabolic cardiovascular syndrome or the "deadly quartet." Individuals with these risk factors are in great need of education and assistance in making lifestyle changes that could decrease their risk of CVD. And, while this study shows they did receive more counseling than patients without diabetes, counseling efforts were still less than 100%.

Barriers to counseling

Primary care physicians have indicated time limitations, inadequate training in counseling techniques, and doubt about the effectiveness of counseling as reasons for the low prevalence of discussions with patients about lifestyle modifications. However, research has shown that physicians can be effective in getting patients to change CVD risk behaviors.

Directing patients to other health care professionals such as registered dietitians, nurses, and fitness trainers may relieve physicians of some of the time restrictions and still provide patients with the assistance they need. Improving counseling skills during medical training or as continuing education may also be beneficial. Armed with knowledge and behavior modification strategies, patients can adopt healthful habits that may minimize their cardiovascular disease risk.

Source

• Modifiable cardiovascular risk factors in adults with diabetes. LE. Egede, D. Zheng,  et al., Arch Int Med , 2002, vol. 162, pp. 427--433

Related Links
Lifestyle Changes Can Reduce Risk of Diabetes
Weight Loss Aids People With Diabetes
A Healthful Lifestyle Can Prevent Type 2 Diabetes
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