National prevalence of lifestyle counseling or referral among African-Americans and whites with diabetes.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Peek
Monica E
ME
Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA. mpeek@medicine.bsd.uchicago.edu
Tang
Hui
H
Alexander
G Caleb
GC
Chin
Marshall H
MH
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000208:ethnology / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000208:ethnology / Q000628:therapy*; D037001:Directive Counseling / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010045:Outpatients; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D040242:Risk Reduction Behavior; D014481:United States / Q000453:epidemiology; D044465:White People; D055815:Young Adult