title: Modifiable cardiovascular risk factors in adults with diabetes: prevalence and missed opportunities for physician counseling.
abstract: BACKGROUND
  Cardiovascular disease (CVD) is the leading cause of death in adults with diabetes mellitus (DM). Counseling by physicians is effective in inducing lifestyle modification.
  
  
  OBJECTIVE
  To determine the prevalence of modifiable CVD risk factors and counseling by physicians among adults with DM.
  
  
  METHODS
  Data on 9496 adults with DM and 150 493 adults without DM from the 1999 Behavioral Risk Factor Surveillance System were analyzed to yield estimates of CVD risk factors and counseling by physicians during routine visits. Multiple logistic regression was used to adjust estimates for age, sex, ethnicity, education, and income. Population estimates were created using software for the statistical analysis of correlated data (SUDAAN) because of the complex survey design of the Behavioral Risk Factor Surveillance System.
  
  
  RESULTS
  Diabetes mellitus was more prevalent in adults aged 55 and older and in blacks and Hispanic or other ethnicities (both P<.001). Modifiable CVD risk factors, such as hypertension (56% vs 22%), high cholesterol (41% vs 20%), obesity (78% vs 57%), and insufficient physical activity (66% vs 56%), were more prevalent in adults with DM (all P<.001) and differed by ethnicity, sex, and age. Counseling about weight loss (50% vs 21%, P<.001), smoking cessation (78% vs 67%, P =.01), eating less fat (78% vs 71%, P<.001), and increasing physical activity (67% vs 36%, P<.001) was less than ideal in both groups and did not change after adjusting for age, sex, ethnicity, education, and income with multiple logistic regression.
  
  
  CONCLUSIONS
  Although adults with DM have a high prevalence of modifiable CVD risk factors, counseling by physicians about lifestyle modification is less than optimal. There is a need to improve patient counseling for lifestyle modification by primary care physicians.
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, McClennan-Banks Adult Primary Care Clinic, Fourth Floor, 326 Calhoun St, PO Box 250100, Charleston, SC 29425, USA.
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
authors.forename: Deyi
authors.initials: D
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D003376:Counseling; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000208:ethnology; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family; D012044:Regression Analysis; D012307:Risk Factors