Implementing behavioral counseling interventions in primary care to modify cardiovascular disease risk in adults with diabetes

Diabetes affects 17 million people in the United States. It was the sixth leading cause of death in 1999, accounting for 19% of all deaths among people 25 years and older. People with diabetes have a two-fold increased risk of death compared with people without diabetes. Cardiovascular disease (CVD) is the leading cause of death in people with diabetes. Among people with diabetes, CVD starts earlier, is more severe, and is more costly than CVD in people without diabetes. Behavioral counseling interventions initiated and coordinated by physicians are effective at decreasing unhealthy lifestyles that increase the risk for CVD in people with diabetes. However, several physician barriers interfere with the ability of primary care physicians to provide effective counseling interventions. This review discusses modifiable CVD risk factors in people with diabetes, barriers to implementation of behavioral counseling interventions in primary care, and practical approaches to clinical counseling in primary care.