Skip to main content
NCBI home page
Canadian Family Physician logoLink to Canadian Family Physician
. 2004 Sep;50:1235–1243.

Lifestyle management for type 2 diabetes. Are family physicians ready and willing?

Stewart B Harris 1, Robert J Petrella 1, Anita Lambert-Lanning 1, Wendy Leadbetter 1, Lynda Cranston 1
PMCID: PMC2214652  PMID: 15508373

Abstract

OBJECTIVE: To determine practices and perceptions of family physicians regarding lifestyle interventions to prevent and manage type 2 diabetes (T2D). DESIGN: Confidential mailed survey. SETTING: Canadian family practices. PARTICIPANTS: Random, stratified sample of 1499 respondents to the 2001 National Family Physician Workforce Survey. MAIN OUTCOME MEASURES: Physicians' self-reported practice patterns and perceptions of lifestyle counseling for patients at risk for, and diagnosed with, T2D. RESULTS: Response rate was 53% (749/1410). Respondents frequently asked patients at risk for, or diagnosed with, T2D about physical activity and weight loss, but far fewer provided written advice, particularly about physical activity. Respondents thought counseling with such interventions as generic patient handouts was preferable to more intensive lifestyle management strategies, such as appointments to provide stage-matched counseling on physical activity. Most respondents thought family physicians should perform lifestyle interventions but realized they are confounded by such barriers as patients' lack of interest and limited referral resources. CONCLUSION: Family physicians keen to implement lifestyle interventions for T2D are hampered by barriers and use of ineffective strategies.

Full Text

The Full Text of this article is available as a PDF (295.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adams A. S., Soumerai S. B., Lomas J., Ross-Degnan D. Evidence of self-report bias in assessing adherence to guidelines. Int J Qual Health Care. 1999 Jun;11(3):187–192. doi: 10.1093/intqhc/11.3.187. [DOI] [PubMed] [Google Scholar]
  2. Agarwal G., Pierce M., Ridout D., Primary Care Diabetes (the Primary Care Section of the British Diabetic Association) The GP perspective: problems experienced in providing diabetes care in UK general practice. Diabet Med. 2002 Jul;19 (Suppl 4):13–20. doi: 10.1046/j.1464-5491.19.s4.4.x. [DOI] [PubMed] [Google Scholar]
  3. Boulé N. G., Haddad E., Kenny G. P., Wells G. A., Sigal R. J. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA. 2001 Sep 12;286(10):1218–1227. doi: 10.1001/jama.286.10.1218. [DOI] [PubMed] [Google Scholar]
  4. Brown Judith Belle, Harris Stewart B., Webster-Bogaert Susan, Wetmore Stephen, Faulds Catherine, Stewart Moira. The role of patient, physician and systemic factors in the management of type 2 diabetes mellitus. Fam Pract. 2002 Aug;19(4):344–349. doi: 10.1093/fampra/19.4.344. [DOI] [PubMed] [Google Scholar]
  5. Coulter A., Schofield T. Prevention in general practice: the views of doctors in the Oxford region. Br J Gen Pract. 1991 Apr;41(345):140–143. [PMC free article] [PubMed] [Google Scholar]
  6. Del Greco L., Walop W., Eastridge L. Questionnaire development: 3. Translation. CMAJ. 1987 Apr 15;136(8):817–818. [PMC free article] [PubMed] [Google Scholar]
  7. Del Greco L., Walop W., McCarthy R. H. Questionnaire development: 2. Validity and reliability. CMAJ. 1987 Apr 1;136(7):699–700. [PMC free article] [PubMed] [Google Scholar]
  8. Del Greco L., Walop W. Questionnaire development: 1. Formulation. CMAJ. 1987 Mar 15;136(6):583–585. [PMC free article] [PubMed] [Google Scholar]
  9. Del Greco L., Walop W. Questionnaire development: 5. The pretest. CMAJ. 1987 May 15;136(10):1025–1026. [PMC free article] [PubMed] [Google Scholar]
  10. Drass J., Kell S., Osborn M., Bausell B., Corcoran J., Jr, Moskowitz A., Fleming B. Diabetes care for Medicare beneficiaries. Attitudes and behaviors of primary care physicians. Diabetes Care. 1998 Aug;21(8):1282–1287. doi: 10.2337/diacare.21.8.1282. [DOI] [PubMed] [Google Scholar]
  11. Eden Karen B., Orleans C. Tracy, Mulrow Cynthia D., Pender Nola J., Teutsch Steven M. Does counseling by clinicians improve physical activity? A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002 Aug 6;137(3):208–215. doi: 10.7326/0003-4819-137-3-200208060-00015. [DOI] [PubMed] [Google Scholar]
  12. Elley C. Raina, Kerse Ngaire, Arroll Bruce, Robinson Elizabeth. Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial. BMJ. 2003 Apr 12;326(7393):793–793. doi: 10.1136/bmj.326.7393.793. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Gerstein H. C., Meltzer S. Preventive medicine in people at high risk for chronic disease: the value of identifying and treating diabetes. CMAJ. 1999 Jun 1;160(11):1593–1596. [PMC free article] [PubMed] [Google Scholar]
  14. Harris Stewart B., Petrella Robert J., Leadbetter Wendy. Lifestyle interventions for type 2 diabetes. Relevance for clinical practice. Can Fam Physician. 2003 Dec;49:1618–1625. [PMC free article] [PubMed] [Google Scholar]
  15. Harris Stewart B., Stewart Moira, Brown Judith Belle, Wetmore Stephen, Faulds Catherine, Webster-Bogaert Susan, Porter Sheila. Type 2 diabetes in family practice. Room for improvement. Can Fam Physician. 2003 Jun;49:778–785. [PMC free article] [PubMed] [Google Scholar]
  16. Knowler William C., Barrett-Connor Elizabeth, Fowler Sarah E., Hamman Richard F., Lachin John M., Walker Elizabeth A., Nathan David M., Diabetes Prevention Program Research Group Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393–403. doi: 10.1056/NEJMoa012512. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Kreuter M. W., Chheda S. G., Bull F. C. How does physician advice influence patient behavior? Evidence for a priming effect. Arch Fam Med. 2000 May;9(5):426–433. doi: 10.1001/archfami.9.5.426. [DOI] [PubMed] [Google Scholar]
  18. Larme A. C., Pugh J. A. Attitudes of primary care providers toward diabetes: barriers to guideline implementation. Diabetes Care. 1998 Sep;21(9):1391–1396. doi: 10.2337/diacare.21.9.1391. [DOI] [PubMed] [Google Scholar]
  19. Larme A. C., Pugh J. A. Evidence-based guidelines meet the real world: the case of diabetes care. Diabetes Care. 2001 Oct;24(10):1728–1733. doi: 10.2337/diacare.24.10.1728. [DOI] [PubMed] [Google Scholar]
  20. Leiter L. A., Barr A., Bélanger A., Lubin S., Ross S. A., Tildesley H. D., Fontaine N., Diabetes Screening in Canada (DIASCAN) Study Diabetes Screening in Canada (DIASCAN) Study: prevalence of undiagnosed diabetes and glucose intolerance in family physician offices. Diabetes Care. 2001 Jun;24(6):1038–1043. doi: 10.2337/diacare.24.6.1038. [DOI] [PubMed] [Google Scholar]
  21. McAvoy B. R., Kaner E. F., Lock C. A., Heather N., Gilvarry E. Our Healthier Nation: are general practitioners willing and able to deliver? A survey of attitudes to and involvement in health promotion and lifestyle counselling. Br J Gen Pract. 1999 Mar;49(440):187–190. [PMC free article] [PubMed] [Google Scholar]
  22. Ockene I. S., Hebert J. R., Ockene J. K., Merriam P. A., Hurley T. G., Saperia G. M. Effect of training and a structured office practice on physician-delivered nutrition counseling: the Worcester-Area Trial for Counseling in Hyperlipidemia (WATCH). Am J Prev Med. 1996 Jul-Aug;12(4):252–258. [PubMed] [Google Scholar]
  23. Ockene I. S., Hebert J. R., Ockene J. K., Saperia G. M., Stanek E., Nicolosi R., Merriam P. A., Hurley T. G. Effect of physician-delivered nutrition counseling training and an office-support program on saturated fat intake, weight, and serum lipid measurements in a hyperlipidemic population: Worcester Area Trial for Counseling in Hyperlipidemia (WATCH). Arch Intern Med. 1999 Apr 12;159(7):725–731. doi: 10.1001/archinte.159.7.725. [DOI] [PubMed] [Google Scholar]
  24. Pan X. R., Li G. W., Hu Y. H., Wang J. X., Yang W. Y., An Z. X., Hu Z. X., Lin J., Xiao J. Z., Cao H. B. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997 Apr;20(4):537–544. doi: 10.2337/diacare.20.4.537. [DOI] [PubMed] [Google Scholar]
  25. Petrella R. J., Wight D. An office-based instrument for exercise counseling and prescription in primary care. The Step Test Exercise Prescription (STEP). Arch Fam Med. 2000 Apr;9(4):339–344. doi: 10.1001/archfami.9.4.339. [DOI] [PubMed] [Google Scholar]
  26. Petrella Robert J., Koval John J., Cunningham David A., Paterson Donald H. Can primary care doctors prescribe exercise to improve fitness? The Step Test Exercise Prescription (STEP) project. Am J Prev Med. 2003 May;24(4):316–322. doi: 10.1016/s0749-3797(03)00022-9. [DOI] [PubMed] [Google Scholar]
  27. Petrella Robert J., Lattanzio Chastity N. Does counseling help patients get active? Systematic review of the literature. Can Fam Physician. 2002 Jan;48:72–80. [PMC free article] [PubMed] [Google Scholar]
  28. Pignone Michael P., Ammerman Alice, Fernandez Louise, Orleans C. Tracy, Pender Nola, Woolf Steven, Lohr Kathleen N., Sutton Sonya. Counseling to promote a healthy diet in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Am J Prev Med. 2003 Jan;24(1):75–92. doi: 10.1016/s0749-3797(02)00580-9. [DOI] [PubMed] [Google Scholar]
  29. Pill R., Stott N. C., Rollnick S. R., Rees M. A randomized controlled trial of an intervention designed to improve the care given in general practice to Type II diabetic patients: patient outcomes and professional ability to change behaviour. Fam Pract. 1998 Jun;15(3):229–235. doi: 10.1093/fampra/15.3.229. [DOI] [PubMed] [Google Scholar]
  30. Potter M. B., Vu J. D., Croughan-Minihane M. Weight management: what patients want from their primary care physicians. J Fam Pract. 2001 Jun;50(6):513–518. [PubMed] [Google Scholar]
  31. Pritchard D. A., Hyndman J., Taba F. Nutritional counselling in general practice: a cost effective analysis. J Epidemiol Community Health. 1999 May;53(5):311–316. doi: 10.1136/jech.53.5.311. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Swinburn B. A., Walter L. G., Arroll B., Tilyard M. W., Russell D. G. The green prescription study: a randomized controlled trial of written exercise advice provided by general practitioners. Am J Public Health. 1998 Feb;88(2):288–291. doi: 10.2105/ajph.88.2.288. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Tuomilehto J., Lindström J., Eriksson J. G., Valle T. T., Hämäläinen H., Ilanne-Parikka P., Keinänen-Kiukaanniemi S., Laakso M., Louheranta A., Rastas M. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001 May 3;344(18):1343–1350. doi: 10.1056/NEJM200105033441801. [DOI] [PubMed] [Google Scholar]
  34. Walop W., Del Greco L., Eastridge L., Marchand B., Szentveri K. Questionnaire development: 4. Preparation for analysis. CMAJ. 1987 May 1;136(9):927–928. [PMC free article] [PubMed] [Google Scholar]
  35. Wylie Graeme, Hungin A. Pali S., Neely Joanne. Impaired glucose tolerance: qualitative and quantitative study of general practitioners' knowledge and perceptions. BMJ. 2002 May 18;324(7347):1190–1190. doi: 10.1136/bmj.324.7347.1190. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada

RESOURCES