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



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.


diabetes race & ethnicity practice variation patient education disparities 



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.


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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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