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. 2011 Sep 26;171(17):1542-50.
doi: 10.1001/archinternmed.2011.400.

Encounter frequency and serum glucose level, blood pressure, and cholesterol level control in patients with diabetes mellitus

Fritha Morrison  1 , Maria Shubina, Alexander Turchin
Affiliations

Encounter frequency and serum glucose level, blood pressure, and cholesterol level control in patients with diabetes mellitus

Fritha Morrison et al. Arch Intern Med. .

Abstract

Background: More frequent patient-provider encounters may lead to faster control of hemoglobin A1c level, blood pressure (BP), and low-density lipoprotein (LDL) cholesterol (LDL-C) level (hereafter referred to as hemoglobin A1c, BP, and LDL-C) and improve outcomes, but no guidelines exist for how frequently patients with diabetes mellitus (DM) should be seen.

Methods: This retrospective cohort study analyzed 26,496 patients with diabetes and elevated hemoglobin A1c, BP, and/or LDL-C treated by primary care physicians at 2 teaching hospitals between January 1, 2000, and January 1, 2009. The relationship between provider encounter (defined as a note in the medical record) frequency and time to hemoglobin A1c, BP, and LDL-C control was assessed.

Results: Comparing patients who had encounters with their physicians between 1 to 2 weeks vs 3 to 6 months, median time to hemoglobin A1c less than 7.0% was 4.4 vs 24.9 months (not receiving insulin) and 10.1 vs 52.8 months (receiving insulin); median time to BP lower than 130/85 mm Hg was 1.3 vs 13.9 months; and median time to LDL-C less than 100 mg/dL was 5.1 vs 32.8 months, respectively (P<.001 for all). In multivariable analysis, doubling the time between physician encounters led to an increase in median time to hemoglobin A1c (not receiving [35%] and receiving [17%] insulin), BP (87%), and LDL-C (27%) targets (P<.001 for all). Time to control decreased progressively as encounter frequency increased up to once every 2 weeks for most targets, consistent with the pharmacodynamics of the respective medication classes.

Conclusions: Primary care provider encounters every 2 weeks are associated with fastest achievement of hemoglobin A1c, BP, and LDL-C targets for patients with diabetes mellitus.

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Figures

Figure 1
Figure 1
Counts of patients excluded from analysis
Figure 2
Figure 2. Encounter Frequency and Time to Treatment Target
Kaplan-Meier curves for time to treatment target from first elevated A1c, BP, or LDL were plotted for different average encounter intervals. Distinct uncontrolled periods (from the first elevated to the first normal measurement) for the same patient were analyzed separately. 2A. Encounter Frequency and Time to A1c Target for Patients off Insulin 2B. Encounter Frequency and Time to A1c Target for Patients on Insulin 2C. Encounter Frequency and Time to BP Target 2D. Encounter Frequency and Time to LDL Target 2E. Encounter Frequency and Time to Combined Target
Figure 2
Figure 2. Encounter Frequency and Time to Treatment Target
Kaplan-Meier curves for time to treatment target from first elevated A1c, BP, or LDL were plotted for different average encounter intervals. Distinct uncontrolled periods (from the first elevated to the first normal measurement) for the same patient were analyzed separately. 2A. Encounter Frequency and Time to A1c Target for Patients off Insulin 2B. Encounter Frequency and Time to A1c Target for Patients on Insulin 2C. Encounter Frequency and Time to BP Target 2D. Encounter Frequency and Time to LDL Target 2E. Encounter Frequency and Time to Combined Target
Figure 2
Figure 2. Encounter Frequency and Time to Treatment Target
Kaplan-Meier curves for time to treatment target from first elevated A1c, BP, or LDL were plotted for different average encounter intervals. Distinct uncontrolled periods (from the first elevated to the first normal measurement) for the same patient were analyzed separately. 2A. Encounter Frequency and Time to A1c Target for Patients off Insulin 2B. Encounter Frequency and Time to A1c Target for Patients on Insulin 2C. Encounter Frequency and Time to BP Target 2D. Encounter Frequency and Time to LDL Target 2E. Encounter Frequency and Time to Combined Target
Figure 2
Figure 2. Encounter Frequency and Time to Treatment Target
Kaplan-Meier curves for time to treatment target from first elevated A1c, BP, or LDL were plotted for different average encounter intervals. Distinct uncontrolled periods (from the first elevated to the first normal measurement) for the same patient were analyzed separately. 2A. Encounter Frequency and Time to A1c Target for Patients off Insulin 2B. Encounter Frequency and Time to A1c Target for Patients on Insulin 2C. Encounter Frequency and Time to BP Target 2D. Encounter Frequency and Time to LDL Target 2E. Encounter Frequency and Time to Combined Target
Figure 2
Figure 2. Encounter Frequency and Time to Treatment Target
Kaplan-Meier curves for time to treatment target from first elevated A1c, BP, or LDL were plotted for different average encounter intervals. Distinct uncontrolled periods (from the first elevated to the first normal measurement) for the same patient were analyzed separately. 2A. Encounter Frequency and Time to A1c Target for Patients off Insulin 2B. Encounter Frequency and Time to A1c Target for Patients on Insulin 2C. Encounter Frequency and Time to BP Target 2D. Encounter Frequency and Time to LDL Target 2E. Encounter Frequency and Time to Combined Target
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