Lifestyle modification to improve blood pressure control in individuals with diabetes: Is physician advice effective?

Abstract

OBJECTIVE - To determine the effectiveness of physician advice on hypertension-related lifestyle modification in individuals with diabetes. RESEARCH DESIGN AND METHODS - Data on adults with one or more physician visit in the 1998 National Health Interview Survey (NHIS) were analyzed (diabetes, n = 1,609; no diabetes, n = 19,672). The proportion with hypertension who received physician advice to lose weight, increase physical activity, or take antihypertensive medications and the proportion who reported adhering to advice were compared by diabetes status. Logistic regression was used to identify factors associated with receipt of physician advice and adherence to advice by diabetes status controlling for covariates. Then, logistic regression was also used to determine the extent to which patient adherence among people with diabetes differed by age, sex, and race/ethnicity, controlling for other covariates. STATA statistical software was used for all analyses to account for the complex survey design of NHIS. RESULTS - Controlling for covariates, individuals with diabetes were more likely to receive advice (odds ratio [OR] 1.94 for weight loss, 1.99 for exercise, and 2.16 for medications). Adherence was more likely in individuals with diabetes (OR 1.40 for losing weight and 2.16 for taking medications). Adherence in people with diabetes did not differ by sex or race/ethnicity. Subjects 18-44 years old were least likely to report losing weight (OR 0.15) or taking medications (0.31) compared with subjects ≥65 years old. CONCLUSIONS - Physician advice appears effective at changing hypertension-related lifestyles in people with diabetes regardless of sex or race/ethnicity. However, advice on increasing physical activity does not seem as effective.