Chronic Disease

Fewer than half of patients with diabetes are referred for lifestyle counseling, nutrition, and exercise

Lifestyle modifications along with proper nutrition and exercise can improve outcomes in patients with diabetes. This is especially important for blacks, who have a disproportionate burden of diabetes compared with whites, such as higher rates of complications and worse control of diabetes-related conditions (high cholesterol, high blood pressure, and obesity). A new study finds that black and white patients with diabetes are referred for lifestyle counseling at similar rates; however, physicians need to be more proactive in counseling and referring these patients.

Researchers examined data from the 2002-2004 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to see if counseling rates were independently associated with patient race. Of the 6,852 patient visits included in the study sample, 69 percent were made by whites and 26 percent by blacks.

The researchers found similar rates of counseling or referral for whites and blacks. Patients were counseled about nutrition either on-site or referred to outside counselors 37 percent of the time. The rate of exercise advice or referral was 19 percent. Factors that favored a patient being counseled/referred for lifestyle modification included being younger, having private insurance, and being diagnosed with an increased number of comorbid illnesses. The latter was the strongest predictor of physician counseling or referral. Patients were also more likely to receive nutrition and exercise interventions if they were seen by a primary care physician.

These results indicate that more ways are needed to increase and enhance the delivery of nutrition and exercise counseling in the outpatient setting, especially in high-risk groups. The study was supported in part by the Agency for Healthcare Research and Quality (HS15699).

See "National prevalence of lifestyle counseling or referral among African-Americans and whites with diabetes," by Monica E. Peek, M.D., M.P.H., Hui Tang, M.S., M.S., G. Caleb Alexander, M.D., M.S., and Marshall H. Chin, M.D., M.P.H., in the November 2008 Journal of General Internal Medicine 23(11), pp. 1858-1864.

Return to Contents
Proceed to Next Article