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Why Monthly Lifestyle Counseling For Patients with Diabetes?

Oct 22, 2019
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Nadeen Ayad, BCPS, PharmD Candidate, Skaggs School of Pharmacy, University of Colorado

Regular monthly lifestyle counseling can have positive long term clinical outcomes in patients with diabetes. 

Patients with diabetes are at increased risk of having a heart attack, stroke or other CV events, so physicians counsel their patients to maintain a healthy lifestyle and diminish that risk. But does counseling help?

According to Alexander Turchin, MD, MS, director of quality in diabetes in the division of endocrinology at Brigham and Women’s Hospital and associate professor at Harvard Medical School in Boston, there was no evidence that lifestyle counseling of any kind had any positive long term clinical outcomes in patients with diabetes. This study was conducted to prove the importance and benefits of regular monthly lifestyle counseling.

Turchin and his colleagues examined electronic medical records from 2000 to 2014 to study the benefits of lifestyle counseling in patients with diabetes. The original study published in July 2019 was to investigate the relationship between regular monthly lifestyle counseling in primary care settings and clinical outcomes in patients with diabetes.

19,293 patients with diabetes were identified (mean age, 58 years; 51% women; mean HbA1c, 7.8%) and included in the study and followed for an average of 5.4 years while keeping records of CV events and all-cause mortality.

They found that patients that underwent regular monthly lifestyle counseling showed a 1.8% reduction in HbA1c during the 2-year assessment period. On the other hand, patients that did not undergo regular counseling had a 0.7% reduction ( P< .0001) only. In addition to that, fewer CV events and all-cause deaths were found among those who had more regular counseling (33% 10- year cumulative incidence rate) vs. those who had less than monthly counseling ( 38.1% 10- year cumulative incidence rate) ( P= .0005). In multivariable analysis, a higher frequency of lifestyle counseling was associated with a lower incidence of CV events in those patients ( HR 0.88 [ 95% CI 0.82-0.94]; P< 0.001).

The combined risk for CV events and all-cause mortality was reduced by 12% for those who had regular monthly counseling vs those who had counseling quarterly only. When the two outcomes were separated, they found that CV event risk was reduced by 11% (HR= 0.89; 95% CI, 0.82-0.97) and all-cause mortality risk reduced by 6% (HR= 0.94; 95% CI, 0.86-1.01).

This study is proof that primary care providers need to develop a relationship with their patients with diabetes to help make a difference in their patients’ lives by providing regular monthly lifestyle counseling. Lifestyle counseling can include talking to them about the importance of exercise and weight loss, advising them about healthy things to eat and what to avoid in their diet, the importance of testing their blood sugars at home, etc. Though the results of lifestyle counseling may not be immediate such as those seen with pharmacological interventions, this study reveals the positive clinical outcomes the patient may gain long term.

Some examples of lifestyle management can include but are not limited to:

      Maintaining a healthy weight

      Eating a balanced diet

      Exercise

      Checking blood sugar at least once daily

      Checking eyes, feet, blood pressure and cholesterol regularly

Practice Pearls:

  • The study included 19,293 diabetic patients that were followed for an average of 5.4 years.
  • Patients that underwent regular monthly counseling showed a 1.8% reduction in HbA1c vs 0.7% reduction in patients that did not undergo regular counseling. The combined risk for CV events and all-cause mortality was reduced by 12%.
  • Primary care providers need to implement regular monthly counseling with their patients with diabetes, in addition to pharmacological interventions, to help diminish the risk of CV events and all-cause mortality.  

Zhang H, et al. Diabetes Care. 2019;doi:10.2337/dc19-0629.

Nadeen Ayad, BCPS, PharmD Candidate, Skaggs School of Pharmacy, University of Colorado