Integrating Lifestyle Therapy for Diabetes Prevention Into Primary Care

The highest diabetes prevalence in the US is among African Americans (13.3%), American Indians (12.8%), and Mexican Americans (9.5%) with 8.7% of European Americans diagnosed with diabetes. In addition, certain minorities also have much higher rates of diabetes-related complications and death, in some instances by as much as 50% more than the general population, highlighting that the greatest need for preventive measures are amongst ethnic minorities.

The efficacy of lifestyle intervention in reducing the incidence of type 2 diabetes has been established by the Diabetes Prevention Program and other studies. The Cook County Bureau of Health Services, a publicly-funded healthcare system serving a primarily low-income, uninsured, ethnically diverse population in Chicago, IL, currently treats an estimated 40,000 patients annually for type 2 diabetes and estimates that another 85,000 to 100,000 patients are at risk for developing diabetes.

Our primary objective was to test the feasibility of integrating less intensive lifestyle intervention therapy into patient visits with their primary care provider to improve weight loss and decrease the intensity of metabolic syndrome and pre-diabetes risk factors. The site of the study is the General Medicine Clinic, a busy primary care outpatient site treating approximately 12,000 patients/year and 200 patients/day, staffed primarily by medical residents supervised by attending physicians.

Inclusion criteria

• Has metabolic syndrome as defined by three or more of the five risk factors:

• elevated blood pressure (BP) above 130 mm Hg systolic and/or 85 mm Hg diastolic or drug therapy for elevated blood pressure
• elevated waist circumference (WC)above 35" (female) or above 40" (male)
• reduced high-density lipoprotein (HDL) of below 40 mg/dl (male) or below 50 mg/dl (female) or drug therapy for reduced HDL
• elevated triglycerides (TG) of 150 mg/dl or above or drug therapy for elevated TG
• elevated fasting blood glucose (FBG) of 100 mg/dl and above and below 126 mg/dl)or pre-diabetes as defined as elevated FBG.
• Has a primary care provider in the General Medicine Clinic (GMC).

Exclusion criteria

• Has been diagnosed with any of the following:

• diabetes
• known CAD (MI, CABG, PTCA)
• congestive Heart Failure NYHA Class III or IV
• Life expectancy less than 2 years
• Non-English speaking patient
• Patient whose physician is a PGY-3 resident, graduating before projected completion of the study