Trends in Lifestyle Counseling for Adults With and Without Diabetes in the U.S., 2005–2015
Open accessAbstract
Introduction Strong evidence shows that lifestyle change and weight loss stimulated by counseling improve glycemic control and lower comorbidities for patients with diabetes, but it is unclear whether diet or physical activity counseling for patients with diabetes in ambulatory settings has actually been responsive to this evidence. Methods Data from the 2005-2015 National Ambulatory Medical Care Surveys were used to assess trends in provider-reported diet or exercise counseling during ambulatory care visits. The data were pooled and multivariate logistic regression models were built, adjusting for patient-, provider-, and practice-level characteristics to examine whether the provision of counseling varied by these characteristics. Data were analyzed from September 2018 to December 2018. Results There were 42,234 adults with diabetes and 272,094 adults without diabetes. The proportions of patients with provider-reported Type 2 diabetes who received any diet or exercise counseling were no different over time, 30% in 2005 (95% CI=25%, 35%) and 25% in 2015 (95% CI=18%, 31%). Lower proportions of those without diabetes received any counseling, 17% in 2005 (95% CI=14%, 19%) and 15% in 2015 (95% CI=11%, 18%). Adjusted models showed that Hispanic patients had a higher likelihood of receiving diet or exercise counseling, compared with whites (OR=1.38, 95% CI=1.09, 1.75). Those aged 30-49 years were more likely to receive diet or exercise counseling than those aged >75 years (OR=1.51, 95% CI=1.27, 1.80). Compared with rural areas and other providers, visits in a metropolitan area (OR=1.27, 95% CI=1.09, 1.47) or with an advanced practice provider (OR=1.66, 95% CI=1.00, 2.75) had a higher likelihood of any diet or exercise counseling delivery. Conclusions Less than 30% of Americans with diabetes receive diet or exercise counseling in ambulatory visits, and this proportion has not changed significantly in a decade. Future interventions should focus on addressing this gap in counseling.
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Less than 30% of diabetic ambulatory visits with healthcare providers include diet or exercise counseling.
“Less than 30% of diabetic ambulatory visits with healthcare providers include diet or exercise counseling.”
From The Impact of Physical Activity in Patients With Type 2 Diabetes (2025) · cites this paper as [96]
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- Authors
- Shah, M. K., Moore, M. A., Narayan, K. M. V., & Ali, M. K.
- Affiliations
- Emory University (US)
- Corresponding author
- Shah, Megha K.
- Venue
- American Journal of Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2019-11
- Volume
- 57
- Issue
- 5
- Pages
- e153-e161
- ISSN
- 0749-3797 (ISSN-L)
- PMC
- PMC6814385
- OpenAlex
- W2980775368
- Cited by
- 17
- References
- 40
- Citations by year
- 2025: 2 · 2024: 6 · 2023: 2 · 2022: 4 · 2021: 2 · 2020: 1
- FWCI
- 1.42
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Center for Advancing Translational Sciences
- Chicago Center for Diabetes Translation Research
- National Institutes of Health (KL2TR002381, UL1TR002378)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Keywords
- type 2 diabetes, lifestyle counseling, nutrition counseling, physical activity counseling, outpatient care, health care utilization trends, Hispanic patients, advanced practice providers, urban-rural differences, glycemic control, National Ambulatory Medical Care Survey, quality of care gaps, physical activity promotion, obesity treatment, health disparities, health care access
- MeSH terms
- Healthy Lifestyle, Professional Practice Gaps, Adolescent, Adult, Aged, Ambulatory Care, Counseling, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Feeding Behavior, Female, Humans, Male, Middle Aged, Obesity, Practice Patterns, Physicians', United States, Weight Loss, Exercise, Comorbidity, Health Care Surveys, Young Adult
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