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Doctors could do more to help adult patients with diabetes reduce their risk of cardiovascular disease

Cardiovascular disease (CVD) is the leading cause of death in adults with diabetes, whose risk of death from CVD is two- to four-fold higher than for similar-aged adults in the general population. Primary care physicians (PCPs) should counsel adults with diabetes to change their lifestyle to reduce CVD risk factors, but findings from a recent study suggest that primary care physicians are doing a less than optimal job in this area. The study was supported in part by the Agency for Healthcare Research and Quality (HS11418 and HS10871).

Strategies to improve counseling techniques among PCPs and incorporate counseling skills into medical residency and continuing medical education programs may be warranted, suggest Leonard E. Egede, M.D., M.S., and Deyi Zheng, M.B., Ph.D., of the Medical University of South Carolina. They analyzed data on nearly 10,000 adults with diabetes and about 150,000 adults without diabetes from the 1999 Behavioral Risk Factor Surveillance System (a telephone survey) to estimate CVD risk factors and physician counseling during routine visits to PCPs.

Diabetes was more prevalent in those aged 55 and older and among blacks, Hispanics, and other ethnic groups. Modifiable risk factors for CVD were more prevalent among adults with diabetes than those without diabetes: hypertension (56 vs. 22 percent), high cholesterol (41 vs. 20 percent), obesity (78 vs. 57 percent), and insufficient physical activity (66 vs. 56 percent), and the risk factors differed by ethnicity, sex, and age.

Although rates of counseling were higher for patients with diabetes than those without, rates for both groups were less than ideal. Rates for those with and without diabetes were 50 vs. 21 percent, respectively, for weight loss; 78 vs. 67 percent for smoking cessation; 78 vs. 71 percent for eating less fat; and 67 vs. 36 percent for increasing physical activity. Group differences did not change after adjusting for the patient's age, sex, ethnicity, education, and income.

There were clearly missed opportunities for PCPs to counsel patients with diabetes at risk for CVD about lifestyle modification, especially since physician counseling has been found to positively affect patient changes in smoking habits, diet, and exercise. PCPs say that they often do not take advantage of these counseling opportunities because they either do not have adequate time to provide counseling, do not know enough about counseling techniques, or are doubtful about the effectiveness of their counseling efforts.

See "Modifiable cardiovascular risk factors in adults with diabetes," by Drs. Egede and Zheng, in the February 25, 2002 Archives of Internal Medicine 162, pp. 427-433.

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