Importance of lifestyle counselling by primary care physicians for diabetic patients

To identify diabetic patients' characteristics and medical care factors associated with recommended glycaemic control (HbA(1c) < or =7%).

As part of a cross-sectional assessment of diabetes care involving 204 Swiss primary care physicians, we identified 366 diabetic patients with a recent HbA(1c) value. Cross-tabulations and X(2) tests were used to explore the association of patients' sociodemographic and disease characteristics and medical care characteristics with HbA(1c) < or =7%. Significant factors were included in a regression logistic model to identify multivariate predictors of HbA(1c) < or =7%.

HbA(1c) values were in the recommended range for 57% of the patients. A less than five years' history of diabetes, absence of followup by a diabetes specialist, absence of microalbuminuria or retinopathy, adherence to dietary and physical activity counselling, no participation in a diabetic education programme, no glycaemic self-monitoring, oral or no antidiabetic therapy and influenza vaccine in the last 12 months were associated with HbA(1c) < or =7%. In the multivariate analysis, HbA(1c) < or =7% remained associated with a less than five years diabetes history (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.5-4.3), as well as patients' adherence to dietary (OR 1.9, 95% CI 1.2-3.0) and physical activity counselling (OR 1.8, 95% CI 1.1-2.9).

In this sample of diabetic patients, adherence to dietary and physical activity counselling were associated with better glycaemic control. Further research should focus on the importance of appropriate lifestyle counselling by Swiss primary care physicians, ideally in prospective trials using objective and reproducible measures of patients' observance.