For primary care physicians caring for patients with type 2 diabetes, it's a familiar conversation: Exercise. Improve your diet. Lose weight. Patients with diabetes are at increased risk of having a heart attack, stroke or other cardiovascular event so physicians counsel their patients on how to make lifestyle changes to help regain control of their blood sugar levels and diminish that risk. But does this counseling help? Should physicians continue advising patients repeatedly? A new study in Diabetes Care suggests that patients who received lifestyle counseling at least once a month were at 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. 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," said corresponding author Alexander Turchin, MD, MS, an endocrinologist in the Brigham's Division of Endocrinology, Diabetes and Hypertension. "And 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."
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," said Turchin. "We're not talking about just changing the numbers, we're talking about preventing strokes, heart attacks, disability and death."
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This study was supported in part by the Patient-Centered Outcomes Research Institute (PCORI CE1304-6756), National Natural Science Foundation of China (91846106,71432004), nonprofit
Central Research Institute Fund of Chinese Academy of Medical Sciences (2017PT32020,2018PT32001), Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (CIFMS2016-I2M-4-001), and Training Program for Excellent Talents in Dongcheng District. Turchin has received research funding from Sanofi, Eli Lilly, and Novo Nordisk; equity in Brio Systems; and personal fees from Monarch Medical Technologies.
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Journal
Diabetes Care