How Often Should Diabetic Patients See Their Primary Care Doctor?

Making primary care visits every 2 weeks leads to faster achievement of glucose, blood pressure, and cholesterol targets in patients with diabetes, reports a study in the Archives of Internal Medicine.

The retrospective study included 26,496 patients with diabetes receiving primary care at two Boston hospitals between 2000 and 2009. The frequency of primary care encounters, assessed from notes in the medical records, was analyzed as a predictor of time to achievement of target levels of hemoglobin A1c, (HbA1c), blood pressure, and LDL cholesterol (LDL-C).

Primary care visits every 1 to 2 weeks were associated with shorter times to reaching all three targets compared with visits every 3 to 6 weeks. For patients not receiving insulin, the HbA1c target of less than 7.0 percent was met at a median of 4.4 months with visits every 1 to 2 weeks compared with 24.9 months for visits every 3 to 6 weeks. For patients using insulin, the medians were 10.1 versus 52.8 months.

Shorter intervals were also associated with faster achievement of a blood pressure under 130/85 mm Hg (1.3 versus 13.9 months) and LDL-C less than 100 mg/dL (5.1 versus 32.8 months). On multivariate analysis, doubling the time between visits increased the time to reaching target HbA1c by 35 percent in patients not using insulin and by 17 percent in those using insulin. Doubling the time between visits also increased the time to lowering blood pressure by 87 percent and time to lowering LDL-C by 27 percent. In general, no further reduction in time to reaching targets was achieved at intervals of less than 2 weeks.

The results suggest that more frequent primary care visits may shorten the time to achieving key clinical targets for patients with diabetes. There is a strong dose–response effect of visit frequency on all three outcomes evaluated. The effect remains significant even after treatment intensification is accounted for. [Morrison F, et al. Encounter frequency and serum glucose level, blood pressure, and cholesterol level control in patients with diabetes mellitus. Arch Intern Med 2011; 171:1542–1550.]

December 2011 (Vol. 3, Number 12)