System-level approaches to improving diabetes care: can asking simple questions improve exercise regimens for patients with diabetes?

Abstract

Clin. Pract. (2014) 11(3), 243–245 ISSN 2044-9038 part of Physical activity is a cornerstone of the healthy lifestyle changes that most patients with Type 2 diabetes mellitus (DM2) must make to manage their condition [1,2]. Regular physical activity improves blood glucose control, blood pressure and quality of life, while lowering harmful cholesterol levels and decreasing cardiovascular events and mortality [1,3–5]. In a joint statement, the American Diabetes Association and American College of Sports Medicine recommend at least 150 min per week of moderate-to-vigorous physical activity (MVPA). MVPA should achieve approximately 40–60% of maximal aerobic capacity, which, for most people, is equivalent to brisk walking [1]. These recommendations, unfortunately, stand in stark contrast with the current reality in American society. Less than 10% of US adults achieve recommended levels of MVPA and over a third engage in no physical activity at all [6]. The twin epidemics of inactivity and overweight/obesity are directly responsible for over a fourth of US healthcare costs, a staggering US$700 billion dollars per year [7,8]. If the status quo remains, over 40% of Americans will be obese and over 50% will have diabetes or prediabetes by the year 2020 [9]. How then, does a modern health system address the daunting task of promoting physical activity in this current culture? Many middle-aged and older adults engage with the primary care setting on a regular basis (between four and eight clinical encounters per year), making this environment potentially highly suitable for implementing population-level programs focused on promoting physical activity [10,11]. Most primary care providers (PCPs), believing that physical activity is an important component of preventive health, report that they provide an integral role in engaging their patients to participate in regular exercise [12]. However, the lack of time and many competing demands during the typical primary care visit represent a significant barrier to adequately addressing physical inactivity. Moreover, despite the known importance of physical activity counseling in primary care, many providers still find it a challenge to provide detailed advice and less than a third of primary care visits include any exercise or lifestyle counseling at all [12–15]. As time constraints continue to tighten for most PCPs, new approaches are needed to help increase exercise levels in patients with diabetes. Clinicians and patients alike will need some assistance. With a prominent emphasis on and rewards provided for ‘meaningful use’ of electronic health records (EHRs) [16], health systems with robust EHRs can play an increasingly influential role in helping to address lack of physical activity. As these systems begin to share information across large populations, an electronic infrastructure is being developed to support clinicians and health systems interested in improving care. New approaches must now be developed and tested to leverage this electronic infrastructure. System-level approaches to improving diabetes care: can asking simple questions improve exercise regimens for patients with diabetes?