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Prevalence and Missed Opportunities for Physician Counseling

Leonard E. Egede, MD, MS; Deyi Zheng, MB, PhD

Arch Intern Med. 2002;162:427-433.

Background  Cardiovascular disease (CVD) is the leading cause of death in adults with diabetes mellitus (DM). Counseling by physicians is effective in inducing lifestyle modification.

Objective  To determine the prevalence of modifiable CVD risk factors and counseling by physicians among adults with DM.

Methods  Data on 9496 adults with DM and 150 493 adults without DM from the 1999 Behavioral Risk Factor Surveillance System were analyzed to yield estimates of CVD risk factors and counseling by physicians during routine visits. Multiple logistic regression was used to adjust estimates for age, sex, ethnicity, education, and income. Population estimates were created using software for the statistical analysis of correlated data (SUDAAN) because of the complex survey design of the Behavioral Risk Factor Surveillance System.

Results  Diabetes mellitus was more prevalent in adults aged 55 and older and in blacks and Hispanic or other ethnicities (both P<.001). Modifiable CVD risk factors, such as hypertension (56% vs 22%), high cholesterol (41% vs 20%), obesity (78% vs 57%), and insufficient physical activity (66% vs 56%), were more prevalent in adults with DM (all P<.001) and differed by ethnicity, sex, and age. Counseling about weight loss (50% vs 21%, P<.001), smoking cessation (78% vs 67%, P = .01), eating less fat (78% vs 71%, P<.001), and increasing physical activity (67% vs 36%, P<.001) was less than ideal in both groups and did not change after adjusting for age, sex, ethnicity, education, and income with multiple logistic regression.

Conclusions  Although adults with DM have a high prevalence of modifiable CVD risk factors, counseling by physicians about lifestyle modification is less than optimal. There is a need to improve patient counseling for lifestyle modification by primary care physicians.

From the Division of General Internal Medicine and Geriatrics, Department of Medicine (Dr Egede), and Department of Biometry and Epidemiology (Dr Zheng), Medical University of South Carolina, Charleston.

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