Exercise. Improve your diet. Lose weight. For primary care physicians caring for patients with type 2 diabetes, these are familiar topics of conversation in the exam room. Because patients with diabetes are at increased risk of having a heart attack, stroke or other cardiovascular event, physicians counsel them on how to make lifestyle changes like these to help them regain control of their blood sugar levels and diminish risk.
But does this counseling help? Should physicians continue advising patients repeatedly? A new Brigham-led study in Diabetes Care suggests that patients who received lifestyle counseling at least once a month were at decreased risk of cardiovascular events — such as heart attacks, strokes and hospitalization for chest pain — as well as death from any cause, compared to those who received counseling less frequently.
“Our study provides real-life evidence that lifestyle counseling can prevent strokes, heart attacks, disabilities and even death. 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,” said corresponding author Alexander Turchin, MD, MS, of the Division of Endocrinology, Diabetes and Hypertension. “And the message for patients is to bring up questions about what you can do to prevent heart attacks and strokes when you see your doctor. Patients can solicit these conversations too and take control of their disease.”
Turchin and colleagues conducted a retrospective analysis of more than 19,000 patients with uncontrolled blood glucose levels who were seen at primary care clinics affiliated with the Brigham and Massachusetts General Hospital between 2000 and 2014. To determine how frequently the patients received lifestyle counseling, the team used a form of artificial intelligence called natural language processing to comb through physicians’ notes recorded in electronic medical records, looking for keywords like “watch his/her diet” or “healthier eating habits.”
The team found that 83 percent of patients received lifestyle counseling less than monthly. Patients who received at least monthly counseling had a greater decrease in their blood glucose levels (1.8 percent vs. 0.7 percent) and had fewer cardiovascular events and death over the next two years (33 percent vs. 38 percent), compared to the group that received less frequent counseling.
Unlike a randomized, controlled clinical trial, the current study analyzed data retrospectively from clinics. A previously published randomized clinical trial, known as Look AHEAD, found that a lifestyle intervention did not reduce the incidence of cardiovascular events in patients with diabetes. Turchin’s study looked at data from nearly four times as many patients and extends previous work indicating that frequent lifestyle counseling can help reduce blood glucose levels.
“As a physician, it’s encouraging to see that these conversations can change outcomes that matter to our patients,” said Turchin. “We’re not talking about just changing blood glucose numbers; we’re talking about preventing strokes, heart attacks, disability and death.”