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Lifestyle Counseling Tied To Better Outcomes For Patients With Diabetes

Exercise. Improve your diet. Lose weight. You’ve probably heard the mantra over and over again.

People living with diabetes know that along with the many added responsibilities of caring for themselves, one of the most important is receiving proper guidance and counseling from their primary care physicians.

But does this counseling really help? And should physicians continue advising patients repeatedly?

Now, a new study suggests that patients who received lifestyle counseling at least once a month were at a decreased risk of cardiovascular events such as heart attacks, strokes, and hospitalization for chest pain as well as death from any cause compared to those who received counseling less frequently.

“Our study provides real-life evidence that lifestyle counseling can prevent strokes, heart attacks, disabilities, and even death,” says Dr. Alexander Turchin, an endocrinologist in the Brigham’s Division of Endocrinology, Diabetes, and Hypertension.

“The message here for physicians is that it’s important to continue having these conversations with patients about the lifestyle changes they can make to lower their risk and to have patients come back in to continue the conversation until their blood glucose levels are under control.”

Turchin says the message for patients is to bring up questions about what you can do to prevent heart attacks and strokes when you see your doctor. “Patients can solicit these conversations too and take control of their disease,” he says.

How Was The Study Conducted?

Turchin and colleagues conducted a retrospective analysis of 19,293 patients with uncontrolled blood glucose levels (HbA1c: 7.0% [53 mmol/mol]) who were seen at primary care clinics affiliated with the Brigham and Massachusetts General Hospital between 2000 and 2014.

To determine how frequently the patients received lifestyle counseling, the team used natural language processing to comb through physicians’ notes recorded in electronic medical records, looking for keywords such as “watch his/her diet,” or “healthier eating habits.”

The team found that most patients (16,057) received lifestyle counseling less than monthly.

Patients who received at least monthly counseling had a greater decrease in their blood glucose levels (1.8 percent vs. 0.7 percent) and had a lower rate of incidences of cardiovascular events and death over the next two years (33 percent vs. 38 percent) compared to the group that received less frequent counseling.

Unlike a randomized, controlled clinical trial, the current study analyzed data retrospectively from clinics.

A previously published randomized clinical trial, known as Look AHEAD, found that a lifestyle intervention did not reduce the incidence of cardiovascular events in patients with diabetes.

Turchin’s study looked at data from nearly four times as many patients and extends previous work indicating that frequent lifestyle counseling can help reduce blood glucose levels.

“As a physician, it’s encouraging to see that these conversations can change outcomes that matter to our patients,” says Turchin. “We’re not talking about just changing the numbers, we’re talking about preventing strokes, heart attacks, disability and death.”

The study was supported in part by the Patient-Centered Outcomes Research Institute, National Natural Science Foundation of China, non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences, Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, and Training Program for Excellent Talents in Dongcheng District.

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