National Prevalence of Lifestyle Counseling or Referral Among African-Americans and Whites with Diabetes

Racial disparities in diabetes prevalence and treatment are well documented. However, little is known about whether race plays a role in how often physicians address lifestyle factors related to diabetes risk, such as diet and exercise. This cross-sectional study used data gathered between 2002–2004 from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to analyze which patient and provider factors were related to referral by physicians for nutrition or exercise counseling. The study sample contained 6,852 patient visits, 69 percent made by non-Hispanic whites, 26 percent by African Americans, and 5 percent by patients classified as "other."

Overall, nutrition referrals or on-site counseling occurred at 37 percent of the visits and exercise referrals occurred in 19 percent of visits. Race was not significantly related to receipt of referral for either service. Insurance type, age, comorbid illness, and other patient factors were predictors of whether patients were referred for either types of counseling services. These rates are fairly low, given the known benefits of lifestyle modification.

Limitations of the study include that referral information was gathered by physician self-report, and may therefore exaggerate the actual number of patients referred. Also, no information was collected about the quality of counseling received and whether this may have differed by patient factor. However, study strengths include nationally representative data, among others. The fact that disparities in counseling referrals did not seem to be related to race is heartening. However, clearly more mechanisms must be identified that can increase physician referrals to services that can help modify lifestyle factors related to diabetes.