Trends in Lifestyle Counseling for Adults With and Without Diabetes in the U.S., 2005-2015

Am J Prev Med. 2019 Nov;57(5):e153-e161. doi: 10.1016/j.amepre.2019.07.005.


Introduction: Strong evidence shows that lifestyle change and weight loss stimulated by counseling improve glycemic control and lower comorbidities for patients with diabetes, but it is unclear whether diet or physical activity counseling for patients with diabetes in ambulatory settings has actually been responsive to this evidence.

Methods: Data from the 2005-2015 National Ambulatory Medical Care Surveys were used to assess trends in provider-reported diet or exercise counseling during ambulatory care visits. The data were pooled and multivariate logistic regression models were built, adjusting for patient-, provider-, and practice-level characteristics to examine whether the provision of counseling varied by these characteristics. Data were analyzed from September 2018 to December 2018.

Results: There were 42,234 adults with diabetes and 272,094 adults without diabetes. The proportions of patients with provider-reported Type 2 diabetes who received any diet or exercise counseling were no different over time, 30% in 2005 (95% CI=25%, 35%) and 25% in 2015 (95% CI=18%, 31%). Lower proportions of those without diabetes received any counseling, 17% in 2005 (95% CI=14%, 19%) and 15% in 2015 (95% CI=11%, 18%). Adjusted models showed that Hispanic patients had a higher likelihood of receiving diet or exercise counseling, compared with whites (OR=1.38, 95% CI=1.09, 1.75). Those aged 30-49 years were more likely to receive diet or exercise counseling than those aged >75 years (OR=1.51, 95% CI=1.27, 1.80). Compared with rural areas and other providers, visits in a metropolitan area (OR=1.27, 95% CI=1.09, 1.47) or with an advanced practice provider (OR=1.66, 95% CI=1.00, 2.75) had a higher likelihood of any diet or exercise counseling delivery.

Conclusions: Less than 30% of Americans with diabetes receive diet or exercise counseling in ambulatory visits, and this proportion has not changed significantly in a decade. Future interventions should focus on addressing this gap in counseling.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Ambulatory Care / statistics & numerical data
  • Ambulatory Care / trends
  • Comorbidity
  • Counseling / statistics & numerical data
  • Counseling / trends*
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / rehabilitation*
  • Exercise / physiology
  • Feeding Behavior / physiology
  • Female
  • Health Care Surveys / statistics & numerical data
  • Healthy Lifestyle / physiology*
  • Humans
  • Male
  • Middle Aged
  • Obesity / epidemiology
  • Obesity / prevention & control*
  • Practice Patterns, Physicians' / statistics & numerical data
  • Practice Patterns, Physicians' / trends*
  • Professional Practice Gaps / statistics & numerical data
  • United States
  • Weight Loss / physiology
  • Young Adult