Physician Counseling Promotes Healthier Lifestyle With Type 2’s

According to a new study, a simple physician counseling process during usual care visits is effective in encouraging sedentary overweight or obese patients with type 2 diabetes to have a healthier lifestyle. “Patients reported that support from their physician was the most important component of the intervention.”

James G. Christian, MSW, MABS, from the PHCC LP in Pueblo, Colorado, writes that,"Physicians are well aware of their potential to positively influence the lifestyle behaviors of patients with diabetes, but the many medical concerns and patient priorities during usual care visits often make it difficult to adequately address lifestyle modifications with each patient. "Time constraints and lack of training on how to effectively counsel patients in nutrition, exercise, and/or weight management are barriers that can interfere with physician counseling about these positive lifestyle changes. To address these challenges, we investigated the efficacy of a simple physician counseling process to aid in delivery of brief but effective lifestyle counseling to sedentary overweight or obese patients with type 2 diabetes during usual care visits."

At 2 large community health centers, 310 patients with a body mass index of 25 kg/m2 or greater were randomized to a 12-month intervention or to a control group. Self-management goals for nutrition and physical activity in the intervention group were set with use of a tailored computer program, and goals were reviewed by physicians at each clinic visit. Patients in the control group received only printed health education materials. Primary endpoints were changes in physical activity and weight.

At 12 months, recommended levels of physical activity increased from 26% at baseline to 53% in the intervention group (P < .001) but did not change significantly in the control group (30% – 37%;
P = .27). In addition, 32% of patients in the intervention group lost 6 or more pounds at 12 months, as did 18.9% of those in the control group (odds ratio, 2.2; P = .006).

"A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss," the study authors write. "Patients reported that support from their physician was the most important component of the intervention. The patients showed continued weight loss between 6 and 12 months, indicating that an approach encouraging modest lifestyle changes can produce sustained benefits over 1 year of intervention."
Limitations of the study include lack of blinding of group assignments, inability to exclude the possibility that physicians also improved their counseling methods for patients assigned to the control group, and study dropout by 34 patients.
"An intervention using patient self-management goal setting and brief physician health lifestyle counseling may be useful in producing positive behavioral change in patients with diabetes," the study authors conclude. "Because the intervention was simple and the burden on physicians was low, it is conceivable that the core components of this simple intervention process could be adopted in other clinical settings."

In an accompanying editorial, David D. McManus, MD, and Ira S. Ockene, MD, from the University of Massachusetts Medical School in Worcester, emphasize the importance of physician counseling in achieving patient treatment goals.
"The results of this study underscore the benefits of brief and supported physician-directed healthy lifestyle counseling while also revealing its limitations," Drs. McManus and Ockene write. "Without improved physician training, more sophisticated and supportive health care systems and a greater societal commitment to public health, health behavior counseling will not realize its full potential."

Practice Pearls:
· Minimal weight loss may improve glycemic control in patients with type 2 diabetes, and exercise may improve glycemic control without reducing body weight. Exercise also seems to be critical in reducing cardiovascular and mortality outcomes among patients with type 2 diabetes, and patients performing moderate levels of exercise should consider increasing exercise intensity.

· The current study demonstrates that a clinic-based support system to help encourage lifestyle changes for patients with type 2 diabetes can improve levels of physical activity and may improve the percentage of patients reaching clinically significant levels of weight loss.

Arch Intern Med. 2008;168:129-130, 141-146.

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