A study published in the September 26 issue of the journal “Archives of Internal Medicine” has demonstrated that diabetics are healthier when they visit their doctors frequently. The patients involved with the study who saw their primary care physicians once every 1 to 2 weeks had a better chance of achieving their clinical goals than patients who saw their doctors less frequently.
Despite the negative implications of elevated levels of LDL cholesterol, blood pressure, and hemoglobin A1c, most diabetics do not meet their target levels for those factors, which are known to be associated with various complications resulting from diabetes. Hemoglobin A1a (or HbA1c) is a test of a diabetic individual’s blood sugar level over an extended period of time — usually six to eight weeks. Normal hemoglobin A1c levels in non-diabetics are between 4 and 6 percent; for most diabetics, the target is 7%.
While there are no established guidelines for how often diabetics should visit their physicians, it is believed that those who interact more frequently with their doctors are quicker to gain control of hemoglobin levels, blood pressure, and LDL cholesterol.
The retrospective cohort study was headed by Fritha Morrisson MPH, with the Division of Endocrinology at Brigham and Women’s Hospital in Boston, Massachusetts. Morrisson’s research team analyzed data 2000 and 2009 for 26,496 patients who had been diagnosed with diabetes. All of the patients had elevated blood pressure, LDL cholesterol, and/or hemoglobin A1c levels; researchers looked for a correlation between frequency of the patients’ visits to their health care providers with the period of time that it took to attain proper control of the three factors.
The patients were divided into groups according to the frequency of visits to their physicians. Patients who were not taking insulin who visited their doctors every 1 to 2 weeks displayed a median time of 4.4 months to attain hemoglobin A1c levels of less than 7%; patients not taking insulin who saw their physicians once every 3 to 6 months showed a median time of 24.9 months to achieve control of those factors. In patients taking insulin, the difference was 10.1 months for the patients who saw their physicians more frequently compared to 52.8 months for patients who recorded less frequent doctor visits.
A multivariate analysis showed that for every doubling of the time between visits with the physician, median time to reaching the target hemoglobin A1c levels increased: patients not taking insulin displayed a 35% increase while patients taking insulin displayed a 17% increase. Blood pressure and LDL cholesterol also showed similar increases as the length of time between doctor visits grew larger.
According to Allan H. Goroll, M.D., MACP, with the Massachusetts General Hospital and Harvard Medical School, the study did have limitations. The retrospective nature of the study was not optimal; a randomized, prospective study would have provided more accurate results. Since the study is retrospective, according to Dr. Goroll, there is no information available about the nature of the doctor visits or the events that triggered changes in patient behavior.
“Understanding how best to deliver… care and change patient behavior, especially in primary care settings, is going to be as important as knowing what care to prescribe,” says Dr. Goroll.
The study was sponsored with grants from the Diabetes Action Research and Education Foundation, the Agency for Healthcare Research and Quality, and the National Library of Medicine. The study’s authors did not disclose any financial interests.
