Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2006 Apr;21(4):378-80.
doi: 10.1111/j.1525-1497.2006.00386.x.

Driving distance as a barrier to glycemic control in diabetes

Kaitlin Strauss  1 , Charles MacLean, Austin Troy, Benjamin Littenberg
Affiliations

Driving distance as a barrier to glycemic control in diabetes

Kaitlin Strauss et al. J Gen Intern Med. 2006 Apr.

Abstract

Background: Despite advances in treatment of diabetes, many barriers to good glycemic control remain.

Objective: To determine the relationship between glycemic control and the driving distance from home to the site of primary care.

Design: Cross-sectional analysis of data from the Vermont Diabetes Information System.

Participants: Nine-hundred and seventy-three adults with diabetes in primary care. The mean age was 64.9 years, 57% were female, and 18.4% used insulin.

Measurements: Hemoglobin A1c, shortest driving distance from a patient's home to the site of primary care calculated by geographic software, self-reported gender, age, education, income, marital status, race, insurance coverage, diabetic complications, and use of insulin and oral hypoglycemic agents.

Results: Controlling for social, demographic, seasonal, and treatment variables, there was a positive, significant relationship between glycemic control and driving distance (beta=+0.07%/10 km, P<.001, 95% confidence interval [CI]=+0.03, +0.11). Driving distance had a stronger association with glycemic control among insulin users (beta=+0.22%/10 km, P=.016, 95% CI=+0.04, +0.40) than among noninsulin users (beta=+0.06%/10 km, P=.006, 95% CI=+0.02, +0.10).

Conclusion: Longer driving distances from home to the site of primary care were associated with poorer glycemic control in this population of older, rural subjects. While the mechanism for this effect is not known, providers should be aware of this potential barrier to good glycemic control.

PubMed Disclaimer

Comment in

  • Letter to the editor regarding Strauss et al.
    Nardone DA. Nardone DA. J Gen Intern Med. 2006 Sep;21(9):1008; author reply 1008. doi: 10.1111/j.1525-1497.2006.00577_3.x. J Gen Intern Med. 2006. PMID: 16918755 Free PMC article. No abstract available.

References

    1. Saaddine JB, Engelgau MM, Beckles GL, Gregg EW, Thompson TJ, Narayan KM. A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med. 2002;136:565–74. - PubMed
    1. Saydah SH, Fradkin J, Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA. 2004;291:335–42. - PubMed
    1. Frame PS. Health maintenance in clinical practice: strategies and barriers. Am Fam Physician. 1992;45:1192–200. - PubMed
    1. Stolar MW. Clinical management of the NIDDM patient. Impact of the American Diabetes Association practice guidelines, 1985–1993. Endocrine Fellows Foundation Study Group. Diabetes Care. 1995;18:701–7. - PubMed
    1. Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458–65. - PubMed

Publication types