Journal of General Internal Medicine

, Volume 23, Issue 11, pp 1858–1864 | Cite as

National Prevalence of Lifestyle Counseling or Referral Among African-Americans and Whites with Diabetes

  • Monica E. Peek
  • Hui Tang
  • G. Caleb Alexander
  • Marshall H. Chin
Populations at Risk

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

KEY WORDS

diabetes race & ethnicity practice variation patient education disparities 

Notes

Acknowledgements

The authors would like to thank Melinda Drum, PhD for her advice regarding survey sampling, survey weights and clustering. This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Diabetes Research and Training Center (P60 DK20595). Dr. Peek is supported by the Robert Wood Johnson Foundation (RWJF) Harold Amos Medical Faculty Development program and the Mentored Patient-Oriented Career Development Award of the National Institute of Diabetes and Digestive and Kidney Diseases (K23 DK075006-01). Dr. Alexander is supported by the Mentored Clinical Scientist Development Award of the Agency for Healthcare Research and Quality (K08 HS15699-01A1) and the Robert Wood Johnson Foundation Faculty Scholars Award. Support for Dr. Chin is provided by a Midcareer Investigator Award in Patient-Oriented Research from the NIDDK (K24 DK071933-01). The funding sources had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; and preparation, review, or approval of the manuscript for publication. Dr. Peek had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. An abstract of this work was presented at the Society of General Internal Medicine 30th Annual Meeting, Toronto, ON, April 25–28, 2007.

Conflicts of Interest

None disclosed.

References

  1. 1.
    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.PubMedCrossRefGoogle Scholar
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    Peek ME, Carglill A, Huang ES. Diabetes health disparities: A systematic review of health care interventions. Med Care Res Rev. 2007;64:101S–56S.PubMedCrossRefGoogle Scholar
  6. 6.
    Nelson KM, Reiber G, Boyko EJ. Diet and exercise among adults with type 2 diabetes. Diabetes Care. 2002;25:1722–8.PubMedCrossRefGoogle Scholar
  7. 7.
    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.Google Scholar
  8. 8.
    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.PubMedGoogle Scholar
  9. 9.
    Rogers LQ, Bailey JE, Gutin B, et al. Teaching resident physicians to provide exercise counseling: a needs assessment. Acad Med. 2002;77:841–4.PubMedCrossRefGoogle Scholar
  10. 10.
    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.Google Scholar
  11. 11.
    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.CrossRefGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    Stafford RS, Farhat JH, Misre B, Schoenfeld DA. National patterns of physician activities related to obesity management. Arch Fam Med. 2000;9:631–8.PubMedCrossRefGoogle Scholar
  19. 19.
    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.PubMedCrossRefGoogle Scholar
  20. 20.
    Binder DA. On the variances of asymptotically normal estimators from complex surveys. Int Stat Rev. 1983;51:279–92.CrossRefGoogle Scholar
  21. 21.
    U.S. Preventive Services Task Force. Behavioral counseling in primary care to promote a healthy diet. Am J Prev Med. 2003;24:93–100.CrossRefGoogle Scholar
  22. 22.
    American Diabetes Association. Standards of medical care in diabetes—2007. Diabetes Care. 2007;30(S1):S4–41.CrossRefGoogle Scholar
  23. 23.
    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; [2001]. Available from U.S. GPO, Washington.Google Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    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.Google Scholar
  27. 27.
    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.Google Scholar
  28. 28.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Monica E. Peek
    • 1
    • 2
    • 3
    • 4
  • Hui Tang
    • 2
    • 3
  • G. Caleb Alexander
    • 1
    • 3
    • 4
  • Marshall H. Chin
    • 1
    • 2
    • 3
    • 4
  1. 1.Section of General Internal Medicine, Department of MedicineUniversity of ChicagoChicagoUSA
  2. 2.Diabetes Research and Training CenterUniversity of ChicagoChicagoUSA
  3. 3.Center for Health and Social SciencesUniversity of ChicagoChicagoUSA
  4. 4.MacLean Center for Clinical Medical EthicsUniversity of ChicagoChicagoUSA

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