Physician Counseling Helps Diabetic Patients Make Lifestyle Changes

According to a new trial, just 15 minutes of Individualized, physician-directed lifestyle counseling appears to help diabetic patients increase physical activity and lose weight.

Ten minutes were spent on a computer answering questions and about five were used to set some goals and create reminders for doctors to ask patients a few more questions.

Half those patients were "controls" — they were given brochures about the risks of diabetes and the importance of nutrition and exercise in controlling the chronic disease. The remaining patients were part of the "intervention" group, which answered questions about their current lifestyle and set personal goals.

Patients in the intervention group were six times more likely to increase their activity levels than those in the control group, and about twice as likely to lose more than 5 percent of their body weight, according to the new report.
This low-cost pilot program run at clinics in Denver and Pueblo could eventually help diabetic patients curb damaging swings in blood sugar, says a report published Monday in the Archives of Internal Medicine.

Lead author James G. Christian, from the Pueblo Community Health Center, states that constraints make it difficult for physicians to adequately address lifestyle modifications with their patients. The investigators tested the effect of brief lifestyle counseling by physicians when patients with type 2 diabetes were seen during routine visits.

The team developed a program in which "self-management goals for nutrition and physical activity were set using a tailored computer program." A separate report generated for the physician provided a bulleted summary and patient-specific counseling recommendations.

"The intervention was simple and the burden on physicians was low," the researchers say.

In their prospective study, Christian’s group randomly assigned 141 patients to the intervention and 132 patients to a usual-care control group. At each 3-month visit, intervention subjects would review their goals with their physician, while control patients received usual care.

"The rate of clinically successful weight loss in the intervention group was 50% higher than in the control group," the investigators report. Although mean changes in weight did not differ significantly between groups, more intervention subjects were able to sustain a weight loss of at least 6 pounds after 1 year (32% vs 19%, p = 0.01).

The intervention subjects were also more likely to engage in at least 150 minutes of moderate physical activity or exercise per week (53% vs 37%).

"It is noteworthy that participants in this study reported that the support from their physician was the most important part of the intervention," write Drs. David D. McManus and Ira S. Ockene at the University of Massachusetts Medical School in Worcester, in an accompanying editorial. "Physicians often under-estimate the value of even brief counseling efforts."

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