<MedWire News: Lifestyle counseling is associated with faster achievement of target glycated hemoglobin (HbA1c), blood pressure, and low-density lipoprotein (LDL) cholesterol levels in routine diabetes care, report US researchers.
"Monthly lifestyle counseling was associated with a particularly strong effect and could be recommended for patients at high risk for complications from uncontrolled diabetes," they say.
Several clinical trials have previously documented the benefit of lifestyle counseling on control of glucose and blood pressure, but many care providers question whether results of extensive clinical trials apply to their practice, explain the authors in Diabetes Care.
To investigate, Alexander Turchin (Harvard Medical School, Boston, Massachusetts) and team studied 30,897 diabetic individuals who had been seen regularly by a primary care physician between January 2000 and January 2010 and who had experienced at least one hyperglycemic, hypertensive, or hyperlipidemic period.
Data from the patients' electronic medical records (EMRs) were used to determine how long they took to achieve control of HbA1c (<7%), blood pressure (<130/85 mm Hg), and LDL cholesterol (<100 mg/dL) with different rates and types of lifestyle counseling.
The team defined "uncontrolled" periods as the time between the date when the relevant measurement was first noted to be above treatment target and the date when the measurement first fell below target. And the length of this uncontrolled period defined the "time to target" for each measurement.
Instances of lifestyle counseling were captured using language processing software to analyze notes recorded in the patients' EMRs that referred to face-to-face or remote interactions in a way which indicated lifestyle counseling had been provided.
The researchers report that, in all treatment categories, time to treatment target increased with less frequent rates of lifestyle counseling.
Patients with a mean face-to-face counseling rate of once or more per month took a median of 3.5 months to achieve target HbA1c levels, compared with 24.7 months among those with a mean face-to-face counseling rate of less than once every 6 months. The corresponding figures for target blood pressure and LDL cholesterol levels were 3.7 weeks versus 5.6 months and 3.5 months versus 24.7 months, respectively.
Multivariate analysis showed that one additional face-to-face lifestyle counseling episode per month was associated with an increased likelihood of achieving control of HbA1c level, blood pressure, and LDL cholesterol, at hazard ratios of 1.7, 1.3, and 1.4, respectively.
The authors say these findings provide evidence for the efficacy of lifestyle counseling as practiced in routine patient care and lend support to the current treatment guidelines for patients with diabetes.
MedWire (http://www.medwire-news.md/) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
Free abstract
