1591-P: Associations of Referral to Wellness Counseling and Diabetes in Midlife Women

Wellness counseling resources have the potential to decrease diabetes risk in high risk populations. Midlife women are at high risk for diabetes because of menopause and aging, and diabetes risk is further increased in women with low levels of physical activity (PA). We determined whether referral to wellness counseling was associated with diabetes risk among midlife women with low PA levels. We identified 64,350 women members of Kaiser Permanente Northern California who were 45-55 years old, did not have diabetes, and reported <10 minutes of PA on PA screening during an appointment with their primary care provider in 2015. We identified referrals to wellness counseling resources within 30 days of the index visit and diabetes diagnoses 2 years after the visit using the electronic health record. Relative risk of diabetes associated with wellness counseling referral was estimated using modified Poisson regression, adjusting for age, race/ethnicity, smoking, and comorbidities. In 2015, 1.6% (n=1029) of midlife women reporting low PA levels were referred to wellness counseling resources. Women who were referred were more likely to be Hispanic (32% vs. 24%) or non-Hispanic Black (14% vs. 9%) and have prediabetes (16% vs. 7%), hypertension (39% vs. 24%), or a cholesterol disorder (26% vs. 20%) than women who were not referred. Our preliminary analysis suggests that referral to lifestyle-related wellness counseling was associated with 2.94 times greater risk of diabetes (95% CI: 2.64, 3.27). Referral to wellness counseling resources among midlife women with low levels of PA at Kaiser Permanente Northern California is low; however, women with diabetes risk factors (minority women and women with comorbidities) were more likely to be referred, which is likely why we observed associations of referral with greater risk of diabetes. Future research should examine whether participation in lifestyle-related wellness counseling resources after referral is effective in decreasing diabetes risk in midlife women.