National Prevalence of Lifestyle Counseling or Referral Among African-Americans and Whites with Diabetes
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Modifiable risk factors such as diet and physical activity contribute to racial disparities among patients with diabetes. Despite this, little is known about how frequently physicians provide counseling or referral to address these risk factors, or whether such rates differ by patient race.
We analyzed cross-sectional data from the 2002–2004 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. We used logistic regression to investigate the relationship between counseling/referral for nutrition or exercise and patient factors, provider factors, and geographic location, with a focus on whether counseling rates were independently associated with patient race.
Overall, counseling/referral for nutrition occurred in 36% of patient visits and counseling/referral for exercise occurred in 18% of patient visits. After adjusting for patient, physician, and practice characteristics, there was no statistically significant association between race and counseling/referral for nutrition (odds ratio for African-Americans compared to whites [OR] 1.00, 95% confidence intervals [CI] 0.71–1.41) or for exercise (OR 0.74, CI 0.49–1.11). Significant predictors of counseling/referral for both lifestyle interventions included younger patient age, private insurance, and treatment by a primary care provider.
Rates of lifestyle modification counseling/referral were similarly low among African-Americans and whites in this national study. Our results highlight a need for interventions to enhance physician counseling for patients with diabetes, particularly those at high-risk for diabetes-associated morbidity and mortality, such as racial/ethnic minorities.
- Mokdad AH, Bowman BA, Ford ES, Vinicor F, Marks JS, Koplan JP. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001;286:1195–200. CrossRef
- Harris MI, Eastman RC, Cowie CC, Flegal KM, Eberhardt MS. Racial and ethnic differences in glycemic control of adults with type 2 diabetes. Diabetes Care. 1999;22:403–7. CrossRef
- Lanting LC, Joung IM, Mackenbach JP, Lamberts SW, Bootsma AH. Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients: a review. Diabetes Care. 2005;28:2280–8. CrossRef
- Sundquist JM, Winkleby A, Pudaric S. Cardiovascular disease risk factors among older Black, Mexican-American, and White women and men: an analysis of NHANES III, 1988–1994. Third national health and nutrition examination survey. J Am Geriatr Soc. 2001;49:109–16. CrossRef
- Peek ME, Carglill A, Huang ES. Diabetes health disparities: A systematic review of health care interventions. Med Care Res Rev. 2007;64:101S–56S. CrossRef
- Nelson KM, Reiber G, Boyko EJ. Diet and exercise among adults with type 2 diabetes. Diabetes Care. 2002;25:1722–8. CrossRef
- Weinstein A, Feigley P, Pullen P, Mann L, Redman L. Neighborhood safety and the prevalence of physical inactivity—selected states, 1996. Morb Mortal Wkly Rep. 1999;48:143–6.
- Horowitz CR, Colson KA, Hebert PL, Lancaster K. Barriers to buying healthy foods for people with diabetes: evidence of environmental disparities. Am J Public Health. 2004;94:1549–54.
- Rogers LQ, Bailey JE, Gutin B, et al. Teaching resident physicians to provide exercise counseling: a needs assessment. Acad Med. 2002;77:841–4. CrossRef
- Peek ME, Chin MH. Care of community-dwelling racial/ethnic minority elders. In: Munshi M, Lipsitz L, eds. Geriatrics Diabetes. New York: or and Francis Group; 2007.
- Nielson PJ, Hafdahl AR, Conn VS, LeMaster JW, Brown SA. Meta-analysis of the effect of exercise interventions on fitness outcomes among adults with type 1 and type 2 diabetes. Diabetes Res Clin Pract. 2006;74:111–20. CrossRef
- Franz MJ, Monk A, Barry B, et al. Effectiveness of medical nutrition therapy provided by dietitians in the management of non-insulin-dependent diabetes mellitus: a randomized, controlled clinical trial. J Am Diet Assoc. 1995;95:1009–17. CrossRef
- Kulkarni K, Castle G, Gregory R, et al. Nutrition practice guidelines for type 1 diabetes mellitus positively affect dietitian practices and patient outcomes. J Am Diet Assoc. 1998;98:62–70. CrossRef
- Eakin EG, Glasgow RE, Riley KM. Review of primary care-based physical activity intervention studies: effectiveness and implications for practice and future research. J Fam Pract. 2000;49:158–168.
- Ma J, Urizar GG Jr, Alehegn T, Safford RS. Diet and physical activity counseling during ambulatory care visits in the United States. Prev Med. 2004;39:815–22. CrossRef
- Mellen PB, Palla SL, Goff DC Jr, Bonds DE. Prevalence of nutrition and exercise counseling for patients with hypertension. United States, 1999 to 2000. J Gen Intern Med. 2004;19:917–24. CrossRef
- Meigs JB, Stafford RS, Randall S. Cardiovascular disease prevention practices by U.S. physicians for patients with diabetes. J Gen Intern Med. 2000;15:220–8. CrossRef
- Stafford RS, Farhat JH, Misre B, Schoenfeld DA. National patterns of physician activities related to obesity management. Arch Fam Med. 2000;9:631–8. CrossRef
- Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative database. J Clin Epidemiol. 1992;45:613–9. CrossRef
- Binder DA. On the variances of asymptotically normal estimators from complex surveys. Int Stat Rev. 1983;51:279–92. CrossRef
- U.S. Preventive Services Task Force. Behavioral counseling in primary care to promote a healthy diet. Am J Prev Med. 2003;24:93–100. CrossRef
- American Diabetes Association. Standards of medical care in diabetes—2007. Diabetes Care. 2007;30(S1):S4–41. CrossRef
- U.S. Department of Health and Human Services. The Surgeon General’s call to action to prevent and decrease overweight and obesity. [Rockville, MD]: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; . Available from U.S. GPO, Washington.
- Jenkins C, McNary S, Carlson BA, et al. Reducing disparities for African-Americans with diabetes: Progress made by the REACH 2010 Charleston and Georgetown diabetes coalition. Public Health Rep. 2004;119:322–30. CrossRef
- Redelmeier DA, Tan SH, Booth GL. The treatment of unrelated disorders in patients with chronic medical diseases. N Engl J Med. 1998;338:1516–20. CrossRef
- Carmen D, Proctor BD, Lee CH. U.S. Census Bureau, Current Population Reports, P60–229. Income, poverty and the health insurance coverage in the United States: 2004. Washington, D.C.: U.S. Government Printing Office; 2005.
- U.S. Congress, House Committee on Energy and Commerce. Subcommittee on Health. The critical role of community health centers in ensuring access to care: hearing before the Subcommittee on Health of the Committee on Energy and Commerce, House of Representatives, 109th Congress. Washington, D.C.: U.S. Government Printing Office; 2006.
- Chin MH, Drum ML, Guillen M, Rimington A, Levie JR, Kirchhoff AC, Quinn MT, Schaefer CT. Improving and sustaining diabetes care in community health centers with the Health Disparities Collaboratives. Medical Care. 2007;45:1135–43. CrossRef
- National Prevalence of Lifestyle Counseling or Referral Among African-Americans and Whites with Diabetes
Journal of General Internal Medicine
Volume 23, Issue 11 , pp 1858-1864
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- race & ethnicity
- practice variation
- patient education
- Industry Sectors
- Author Affiliations
- 1. Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
- 2. Diabetes Research and Training Center, University of Chicago, Chicago, IL, USA
- 3. Center for Health and Social Sciences, University of Chicago, Chicago, IL, USA
- 4. MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA