Missed Opportunities for Providing Low-fat Dietary Advice to People With Diabetes

Ingrid E. Lobo, MD; Daniel le F. Loeb, MD; Vahram Ghushchyan, PhD; Irene E. Schauer, MD, PhD; Amy G. Huebschmann, MD

Disclosures

Prev Chronic Dis. 2012;9 

In This Article

Results

The following demographic factors were related to a greater likelihood of receiving low-fat dietary advice (Table 1): age of 45 or older, a high school degree or more, middle or high income, Hispanic ethnicity, black race, having health insurance, not currently smoking, and residing in the Northeast. Each age group aged 45 or older was more likely to receive low-fat dietary advice than the group aged younger than 45. Sex was not related to the likelihood of receiving low-fat dietary advice. The unadjusted rates of advice increased from 30.6% in 2002 to 35.6% in 2009. The likelihood of receiving low-fat dietary advice decreased from 2004 to 2009, compared with the reference year 2002 (adjusted odds ratio [AOR] in 2004, 0.97; AOR in 2009, 0.88).

The likelihood of receiving low-fat dietary advice was also related to diabetes status and other risk factors for type 2 diabetes (Table 2). Among respondents who had diabetes, the unadjusted rate of receiving advice was 70.6%; the rate among respondents who did not have diabetes or risk factors for diabetes was 7.4%, and the rate among respondents who did not have diabetes but had at least 1 risk factor was 32.4%. Respondents who had diabetes were almost twice as likely to receive low-fat dietary advice as respondents who did not have diabetes (controlling for type and number of risk factors for diabetes). Unadjusted rates of low-fat dietary advice ranged according to type of risk factor — from 34.3% (BMI 25.0–29.9) to 75.9% (hyperlipidemia).

Some risk factors for type 2 diabetes were more closely related to low-fat dietary advice than others. Respondents who had hyperlipidemia were almost 5 times as likely to receive advice as respondents who did not have this risk factor. Obese respondents were 3.5 times as likely to receive advice as normal-weight respondents. Respondents who had CVD were 1.6 times as likely to receive advice as respondents who did not have CVD.

Participants with 1 risk factor for type 2 diabetes were more than twice as likely to receive low-fat dietary advice as respondents with no diabetes and no risk factors (Figure). As the number of risk factors increased, the likelihood of receiving low-fat dietary advice increased.

Figure.

Likelihood of receiving low-fat dietary advice, by number of risk factors for type 2 diabetes and by diabetes status, Medical Expenditure Panel Survey, 2002–2009 (n = 188,006). Adjustment covariates were population characteristics (age, sex, race, ethnicity, education, federal poverty index, and geographic region), smoking status, dummy variables for each potential number of diabetes risk factors, and the modified clinical comorbidity index.25 The reference group includes respondents who had no diabetes and no risk factors for diabetes type 2. Error bars represent 95% confidence intervals.

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