medwireNews: Regularly counseling patients with diabetes about their lifestyles during routine care could benefit their long-term clinical outcomes, US research suggests, possibly due to improved blood glucose control.
Among 19,293 primary care patients with uncontrolled diabetes retrospectively tracked between 2000 and 2014, the 10-year cumulative incidence of cardiovascular (CV) events and death was significantly lower when lifestyle counseling was provided at least once a month compared with less frequently, at 33.0% versus 38.1%.
Despite this, more than eight in every 10 patients studied did not receive lifestyle counseling at least monthly.
The counseling benefits remained after accounting for other aspects of diabetes care, such as intensifying diabetes medications or contact between patients and healthcare providers, the researchers note.
Multivariate analysis revealed that lifestyle counseling every month versus every 3 months was significantly protective, with a hazard ratio (HR) for the composite primary outcome of CV events and death of 0.88. This was primarily driven by a significant reduction in CV events (HR=0.89), whereas there was no significant protection against death when the two outcomes were examined individually.
The association between lifestyle counseling and outcomes appeared to be mediated by changes in glycated hemoglobin (HbA1c) levels, the researchers note
All participants initially had HbA1c levels of at least 7.0% (53 mmol/mol), with a median baseline level of 7.8% (62 mmol/mol), and they received lifestyle counseling a median of 0.46 times per month during hyperglycemic periods.
During the 2-year treatment assessment period, HbA1c decreased by 1.8% among patients receiving lifestyle counseling at least monthly, compared with just 0.7% among those receiving less frequent counseling, a statistically significant difference.
And when time-weighted HbA1c during the treatment assessment period was added to the multivariable analysis as a covariate, the link between the frequency of lifestyle counseling and the primary outcome lost its statistical significance.
“As an observational analysis, this investigation does not provide direct evidence for a causal relationship and can only establish an association,” the researchers point out. “However, mediation of the lifestyle counseling’s association with clinical outcomes by changes in HbA1c is consistent with our understanding of the pathophysiology of complications of diabetes and provides indirect support for causality.”
Alexander Turchin (Brigham and Women’s Hospital, Boston, Massachusetts) and colleagues acknowledge in Diabetes Care that the large Look AHEAD trial previously found that lifestyle intervention did not reduce CV events in patients with diabetes, but add that those patients did not attain sustained blood glucose reductions.
Turchin told the press: “The message here for physicians is that it's important to continue having these conversations with patients about the lifestyle changes they can make to lower their risk and to have patients come back in to continue the conversation until their blood glucose levels are under control.”
By Anita Chakraverty
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