Most people who have diabetes are likely familiar with the steps that are important to blood glucose control, including checking blood glucose levels frequently to discover patterns and take corrective actions, getting an adequate amount of exercise, maintaining a healthful diet, and getting plenty of sleep. Now, new research published in the Archives of Internal Medicine indicates that, in people with poorly controlled Type 2 diabetes, another factor may be linked with achieving blood glucose control: frequent visits with their primary-care provider.
Other than recommending that A1C (an indicator of blood glucose control) be checked every three months, there are few official guidelines that directly address how often people with diabetes should see their doctors. To determine whether visit frequency is related to improvement in health markers such as A1C, blood pressure, and cholesterol levels — all associated with the risk of complications — researchers from Brigham and Women’s Hospital in Boston looked at 26,496 people with Type 2 diabetes and elevated A1C, blood pressure, and/or cholesterol levels who had been treated by primary-care doctors between 2000 and 2009. The relationship between frequency of visits and the time it took to control blood glucose, blood pressure, and cholesterol was assessed. Control was defined as an A1C level of less than 7%, a blood pressure of less than 130/85 mmHg, and an LDL (low-density lipoprotein, or “bad”) cholesterol level of less than 100 mg/dl.
Analysis showed that halving the time between doctor visits reduced the time to reach target levels by as much as 35% for A1C, 87% for blood pressure, and 27% for cholesterol. People who had a doctor visit every one to two weeks achieved control the quickest, with a median (midpoint) time of 4.4 months (without insulin) and 10.1 months (with insulin) to reach A1C target levels, 1.3 months to reach blood pressure target levels, and 5.1 months to reach cholesterol target levels. Among those who saw their doctor only once every three to six months, median time to reach target levels was 24.9 months (without insulin) and 52.8 months (with insulin) for A1C, 13.9 months for blood pressure, and 32.8 months for cholesterol.
The most likely cause for better control with more frequent visits is the ability to intensify medical treatment more rapidly, the researchers suggest.
According to the study’s authors, “The present findings provide evidence that for many patients with elevated hemoglobin A1C, BP [blood pressure], or LDL-C, more frequent patient-provider encounters were associated with a shorter time to treatment target, and control was fastest at two-week intervals.” Achieving control more rapidly might have the advantages of lower risk of cardiovascular complications, as well as longer lasting control.
The authors further note that, because of the retrospective nature of the study and a lack of information on what happened during the doctor visits, they were not able to determine whether these frequent visits actually caused the better health outcomes. In an accompanying editorial, Allan H. Goroll, MD, advised that a doctor visit every two weeks shouldn’t yet be considered the standard of care for people with uncontrolled diabetes and joined the study authors in calling for further research on the matter.
To learn more, read the pieces “Frequent Care Best to Get to Diabetes Goal” and “Frequent Office Visits Improve Outcomes for Patients With Diabetes” or see the study’s abstract in the Archives of Internal Medicine.
And to learn about improving the quality of your doctor visits, check out this article by diabetes specialist Laura Hieronymus and clinical endocrinologist Wendell Miers.