Lifestyle advice for hypertension or diabetes: trend analysis from 2002 to 2017 in England

BACKGROUND: Guidelines recommend that GPs give patients lifestyle advice to manage hypertension and diabetes. Increasing evidence shows that this is an effective and practical treatment for these conditions, but it is unclear whether GPs offer this support. AIM: To investigate trends in the percentage of patients with hypertension/diabetes receiving lifestyle advice versus medication. DESIGN AND SETTING: This was a trend analysis of self-reported data from the annual Health Survey for England (HSE) (2003–2017) and GP-recorded data from the QResearch database (2002–2016). METHOD: The percentage of patients with hypertension or diabetes who received lifestyle advice or medication was calculated in each year. Associations between likelihood of receiving lifestyle advice and characteristics were assessed using multivariable logistic regression. RESULTS: The percentage of patients receiving lifestyle advice was consistently lower than those receiving medication in both self-reported and medical records. There was consistent evidence of increasing trends in the percentage of patients with hypertension receiving lifestyle advice (HSE 13.8% to 20.1%; P(trend)<0.001; QResearch 11.0% to 22.7%; P(trend)<0.001). For diabetes, there was a non-significant decline in self-reported receipt of lifestyle advice (45.0% to 27.9%; P(trend) = 0.111) and a significant increase in medically recorded delivery of this advice (20.7% to 40.5%; P(trend)<0.001). Patients with hypertension who were overweight or obese were more likely to receive lifestyle advice than those of a healthy weight, whereas the opposite was true for diabetes. CONCLUSION: Only a minority of patients with diabetes or hypertension report receiving lifestyle advice or have this recorded in their medical records. Interventions beyond guidelines are needed to increase the delivery of behavioural interventions to treat these conditions.