Regular Doctor Helps Glycemic Control

Abstract & Commentary

Synopsis: A regular health care provider for diabetes can improve some of the more generally recognizable criteria for intensive care in glycemic control.

Source: O’Connor PJ, et al. J Fam Pract 1998;47:290-297.

Evidence has suggested that intensive diabetic care is associated with better clinical outcomes. Therefore, O’Connor and associates looked at 144 health maintenance organization (HMO) members who did not have a regular health care provider vs. 1243 who did. By first adjusting for age, race, gender, co-morbidity, years of education, duration of diabetes, and type of HMO clinic, O’Connor et al then looked at some specific parameters that would suggest whether a patient was being more intensively controlled.

They found a P value of significance for the following: a special diet for diabetes, regularly monitoring their own glucose levels at home, greater frequency of glycosylated hemoglobin, more foot examinations, recommended cholesterol checks and preventive examinations.

There were no differences for dental checkups or endocrine referrals. This study was conducted in Minnesota, known as a hot bed of HMOs through a large HMO with 700,000 members.

O’Connor et al identified the patients by looking at the diabetic drugs the patients were placed on and then performed a 16-page, 61-item diabetes survey on all of the patients. By correcting for the parameters listed above, they were then able to statistically analyze whether those parameters generally thought to be an indicator of good glycemic control were being differentiated by whether a person had a regular provider. They found in multiple areas, including diet, regular monitoring of glucose level, hemoglobin A1C testing, foot examinations, and cholesterol checks, that having a regular primary care practitioner increased the chance that a diabetic would have those tests.

Having a regular provider of diabetes care can improve parameters generally thought to be correlated with intensive diabetes care.

Comment by Len Scarpinato, DO

Ever since the release of the DCCT trial, tightly controlling diabetes has been the mantra among diabetic educators. One of the more difficult aspects of this has been the more frequent office visits, tighter control, and more frequent blood testing that must occur in patients. As a primary care physician, I have always suspected that patients did better if they had a primary care provider. What O’Connor et al have done for me in this specific area of diabetes has proven this fact.

HMOs and other organizations are looking for methods to delineate tighter control of diabetes and, therefore, reduce complications of diabetes. When a group of physicians or an organization can go to an HMO and say that their patients are more likely to spend time at a regular provider’s office rather than urgent care, O’Connor et al have now shown us that those patients will likely have tighter diabetic control. Alternatively, we may see HMOs and other organizations now putting "money where their mouth is" and supporting physicians and organizations where continuity of care is emphasized with their patients.

I, for one, have been supportive of this over the years and believe it is the true and correct way to go. I will continue to re-enforce with my patients that having a regular provider of diabetes care will enhance their care and better control their diabetes.