Lifestyle counseling in routine care and long-term glucose, blood pressure, and cholesterol control in patients with diabetes.
Lifestyle counseling in routine care and long-term glucose, blood pressure, and cholesterol control in patients with diabetes.
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DOI：
10.2337/dc11-1635
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发表时间：
2012-02
期刊：
影响因子：
16.2
通讯作者：
Turchin A
中科院分区：
文献类型：
--
作者：
Morrison F;Shubina M;Turchin A
在临床试验中，饮食，运动和体重咨询导致糖尿病患者血糖，血压和胆固醇水平的短期改善。然而，很少有人知道的长期影响的生活方式咨询糖尿病患者在常规的临床设置。这项对30,897例糖尿病患者的回顾性队列研究旨在确定生活方式咨询是否与糖尿病患者的A1 C，血压和LDL胆固醇控制时间相关。如果患者在2000年1月1日至2010年1月1日期间在马萨诸塞州东部的两家教学医院附属的初级保健实践中接受了至少2年的随访，则将其纳入研究。比较每月一次或多次面对面咨询率与每6个月不到一次的患者，A1 C <7.0%的中位时间为3.5个月与22.7个月，血压<130/85 mmHg的时间为3.7周与5.6个月，LDL胆固醇<100 mg/dL的时间为3.5个月与24.7个月，P < 0.0001。在多变量分析中，每月增加一次面对面的生活方式咨询与A1 C控制的风险比为1.7（P < 0.0001），血压控制的风险比为1.3（P < 0.0001），LDL胆固醇控制的风险比为1.4（P = 0.0013）。 初级保健环境中的生活方式咨询与更快实现A1 C，血压和LDL胆固醇控制密切相关。这些结果证实了对照临床试验的结果适用于常规护理环境，并为支持当前的治疗指南提供了证据。
In clinical trials, diet, exercise, and weight counseling led to short-term improvements in blood glucose, blood pressure, and cholesterol levels in patients with diabetes. However, little is known about the long-term effects of lifestyle counseling on patients with diabetes in routine clinical settings. This retrospective cohort study of 30,897 patients with diabetes aimed to determine whether lifestyle counseling is associated with time to A1C, blood pressure, and LDL cholesterol control in patients with diabetes. Patients were included if they had at least 2 years of follow-up with primary care practices affiliated with two teaching hospitals in eastern Massachusetts between 1 January 2000 and 1 January 2010. Comparing patients with face-to-face counseling rates of once or more per month versus less than once per 6 months, median time to A1C <7.0% was 3.5 versus 22.7 months, time to blood pressure <130/85 mmHg was 3.7 weeks versus 5.6 months, and time to LDL cholesterol <100 mg/dL was 3.5 versus 24.7 months, respectively (P < 0.0001 for all). In multivariable analysis, one additional monthly face-to-face lifestyle counseling episode was associated with hazard ratios of 1.7 for A1C control (P < 0.0001), 1.3 for blood pressure control (P < 0.0001), and 1.4 for LDL cholesterol control (P = 0.0013). Lifestyle counseling in the primary care setting is strongly associated with faster achievement of A1C, blood pressure, and LDL cholesterol control. These results confirm that the findings of controlled clinical trials are applicable to the routine care setting and provide evidence to support current treatment guidelines.