title: Clustering of unhealthy lifestyle behaviors is associated with nonadherence to clinical preventive recommendations among adults with diabetes.
abstract: OBJECTIVE
  Analyze clustering of unhealthy lifestyle behavior and its relationship with nonadherence to clinical preventive care services among Spanish diabetic adults.
  
  
  METHODS
  Cross-sectional study including 2156 diabetic adults from the 2006 Spanish National Health Survey. Subjects were asked about their uptake of BP measurement, lipid profile, influenza vaccination, and dental examination. Lifestyle behaviors included smoking status, physical activity, alcohol consumption, and dieting. Binary logistic regression models were built to assess the association between clustering of unhealthy lifestyle and the uptake of each preventive activity.
  
  
  RESULTS
  Almost 16% and 36% of the subjects had not undergone blood pressure (BP) and blood lipids measurements, respectively. Forty percent had not been vaccinated and 72% had not received dental examination. Fourteen percent of the subjects had three to four unhealthy behaviors and this increased the probability of not having BP check-up (OR 2.32, 95% CI 1.38-3.91), blood lipids testing (OR 1.63, 95% CI 1.14-2.33), and not being vaccinated (OR 1.99, 95% CI 1.37-2.89). Number of unhealthy lifestyle behaviors is linearly associated with number of preventive measures unfulfilled.
  
  
  CONCLUSIONS
  Adherence to recommended clinical preventive services is under desirable levels among Spanish diabetes sufferers. These preventive services are provided neither equitably nor efficiently, since subjects with unhealthier lifestyles are less likely to receive them.
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón 28922, Madrid, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jiménez-García
authors.forename: Jesus
authors.initials: J
authors.lastname: Esteban-Hernández
authors.forename: Valentín
authors.initials: V
authors.lastname: Hernández-Barrera
authors.forename: Isabel
authors.initials: I
authors.lastname: Jimenez-Trujillo
authors.forename: Ana
authors.initials: A
authors.lastname: López-de-Andrés
authors.forename: Pilar
authors.initials: P
authors.lastname: Carrasco Garrido
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000453:epidemiology / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006262:Health; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D011322:Primary Prevention / Q000379:methods / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult