Lifestyle counseling in routine care and long-term glucose, blood pressure, and cholesterol control in patients with diabetes

Abstract

Objective: In 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 methods: This 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.

Results: Comparing 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.

Figure 1

Lifestyle counseling frequency and time to treatment target. Kaplan-Meier curves for time to treatment target from first elevated A1C, blood pressure, or LDL cholesterol were plotted for different average counseling rates. Distinct uncontrolled periods (from the first elevated to the first normal measurement) for the same patient were analyzed separately. A: Lifestyle counseling frequency and time to A1C target. B: Lifestyle counseling frequency and time to blood pressure target. C: Lifestyle counseling frequency and time to LDL cholesterol target. D: Lifestyle counseling frequency and time to combined target. DBP, diastolic blood pressure; LDL, LDL cholesterol; SBP, systolic blood pressure.