HUABING ZHANG,NAOSHI HOSOMURA, MARIA SHUBINA, DONALD C. SIMONSON, MARCIA A. TESTA, ALEXANDER TURCHIN

Electronic Documentation of Lifestyle Counseling in Primary Care is Associated with Lower Risk of Cardiovascular Events in Patients with Diabetes. HUABING ZHANG,NAOSHI HOSOMURA, MARIA SHUBINA, DONALD C. SIMONSON, MARCIA A. TESTA, ALEXANDER TURCHIN, Beijing, China and Boston,MA

Hyperglycemia carries an increased risk of macrovascular complications. Lifestyle interventions can improve glycemic control. However, clinical outcomes of lifestyle counseling in diabetes remain uncertain.
We retrospectively studied hyperglycemic (HbA1c ≥7.0%) adults with diabetes followed at primary care practices affiliated with two academic medical centers between 2000 and 2014. Lifestyle (diet, exercise and weight loss) counseling documentation was extracted from EMR notes using previously validated natural language processing software.mAmong 19,514 study patients, an average of 7.2 episodes of lifestyle counseling were documented annually. Patients were followed for a mean of 1,868 days. Over this time 2,878 (11.4%) of patients had at least one cardiovascular (CV) event (myocardial infarction, stroke or hospitalization for unstable angina. In Cox multivariable analysis (adjusted for patient demographics, history of smoking, body mass index, blood pressure, baseline HbA1c, kidney function, treatment with insulin, family history of coronary artery disease and stroke, Charlson Comorbidity Index, number of ED visits and hospitalizations over the preceding 12 months, frequency of primary care visits and frequency of diabetes medication intensification) frequency of lifestyle counseling was associated with lower risk of CV events in patients without baseline CV disease (HR 0.817 for one lifestyle counseling per month; p=0.0055) but not in patients with (HR 0.987; p=0.865) baseline CV disease. The association of lifestyle counseling and CV events was attenuated by adjustment for time-weighted HbA1c during the study period (HR 0.895; p=0.0962).
In this large, long-term retrospective study of patients with poorly controlled diabetes, lifestyle counseling was associated with lower risk of CV events in patients without baseline CV disease. This association was at least partially mediated by changes in HbA1c levels.

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