Adults with diabetes who took part in monthly lifestyle counseling appeared to reduce their risks for cardiovascular events and all-cause mortality compared with those who did not undergo regular counseling, according to findings published in Diabetes Care.
“Until now, there was no evidence that lifestyle counseling of any kind improved patient outcomes. There was evidence that it lowers blood glucose, weight, blood pressure, etc, but these are just numbers,” Alexander Turchin, MD, MS, director of quality in diabetes in the division of endocrinology at Brigham and Women’s Hospital and associate professor at Harvard Medical School in Boston, told Endocrine Today. “Ours is the first study to show that lifestyle counseling — as practiced in the everyday primary care setting —may be impacting outcomes that matter to patients — myocardial infarctions, strokes and death.”
Turchin and colleagues examined electronic medical records from 2000 to 2014 at Brigham and Women’s Hospital and Massachusetts General Hospital in Boston, with natural language processing technology revealing instances of lifestyle counseling. They identified 19,293 adults with diabetes (mean age, 58 years; 51% women; mean HbA1c, 7.8%), who they included in the study and followed for an average of 5.4 years, recording instances of cCV events and all-cause mortality.
Participants who took part in lifestyle counseling at least once a month experienced a 1.8% reduction in HbA1c during the 2-year treatment assessment period, whereas those without regular counseling had a 0.7% reduction (P < .0001), according to the researchers. Results also showed fewer CV events and all-cause deaths among those who had more regular counseling (33% 10-year cumulative incidence rate) vs. those who had less than monthly counseling (38.1% 10-year cumulative incidence rate) (P = .0005).
The combined risk for CV events and all-cause death was reduced by 12% for those who had monthly counseling compared with those who had counseling quarterly (HR = 0.88; 95% CI, 0.82-0.94). When these two outcomes were separated, the researchers found that CV event risk was reduced by 11% (HR = 0.89; 95% CI, 0.82-0.97) and all-cause mortality risk was lowered by 6% (HR = 0.94; 95% CI, 0.86-1.01) for those who underwent monthly counseling compared with those who underwent counseling on a quarterly basis.
“This research shows that everyday primary care providers can make a difference in their patients’ lives by talking to them about their diet, exercise and weight loss,” Turchin told Endocrine Today. “Many of us clinicians can find this experience challenging without immediate returns we see with pharmacological interventions. This research shows it pays to persevere.” – by Phil Neuffer
Disclosure: Turchin reports equity in Brio Systems and research funding from Eli Lilly, Novo Nordisk and Sanofi as well as personal fees from Monarch Medical Technologies.