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Issue 95 Item 8 Diabetics Need Greater Awareness Of Cardiovascular Risk Factors

Adults with diabetes mellitus have a high prevalence of modifiable cardiovascular disease (CVD) risk factors but often are not counseled by doctors on how to change their lifestyles. ;There is a need to improve patient counseling for lifestyle modification by primary-care physicians," United States researchers say. "Although adults with diabetes mellitus have a high prevalence of modifiable CVD risk factors, counseling by physicians about lifestyle modification is less than optimal."

Investigators from the Medical University of South Carolina in Charleston say adult diabetics are more likely to have modifiable risk factors than are non-diabetic adults that differ by ethnicity, sex and age. "There is a need for primary care physicians to recognize the prevalence of modifiable CVD risk factors among adults with DM," they suggest. "Recognizing the pattern in which these CVD risk factors cluster in people with DM may improve identification of high-risk patients."

Researchers say lack of counseling "may suggest that strategies to improve counseling techniques in primary care are needed, especially on how to counsel patients to modify high-risk behavior? There may be benefit in incorporating counseling skills into medical residency education or as continuing medical education activity for primary-care physicians."

Investigators analyzed data on 9,496 diabetic adults and 150,493 non-diabetics for estimates of both CVD risk factors and counseling by doctors during routine medical visits. Data came from the 1999 US Behavioral Risk Factor Surveillance System.

"Diabetes mellitus was more prevalent in adults aged 55 and older and in blacks and Hispanic or other ethnicities," they report. "Modifiable CVD risk factors such as hypertension, high cholesterol, obesity and insufficient physical activity were more prevalent in adults with diabetes mellitus and differed by ethnicity, sex and age."

Hypertension prevalence was 56 percent in diabetics, compared to 22 percent in non-diabetics. High cholesterol was found in 41 percent of diabetics and only 20 percent of non-diabetics. Approximately 78 percent of diabetics were obese, compared with 57 percent of non-diabetics.

"Counseling about weight loss, smoking cessation, eating less fat and increasing physical activity was less than ideal in both groups and did not change after adjusting for age, sex, ethnicity, education and income," researchers add.

They point out that distributions of ethnicity, sex and age among diabetic adults included in the study were consistent with those of previous diabetes studies.

"Finding of a higher prevalence of modifiable CVD risk factors among people with diabetes mellitus is not surprising," investigators suggest.

"Clustering in certain individuals of diabetes, hypertension, high cholesterol and obesity – known as the metabolic cardiovascular syndrome or the ‘deadly quartet’ – has been described." Archives of Internal Medicine, 2002; 162: 427-433.