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Having a regular source of primary care helps adults with diabetes manage their diet and improve glucose control

About 90 percent of all people with diabetes in the United States receive their medical care from a primary care provider (PCP). A new study found that for adults with adult-onset (type 2) diabetes, continued care from the same PCP was significantly associated with better blood glucose control (HbA1c level), regardless of how long the patient had suffered from diabetes.

In the study, which was supported in part by the Agency for Healthcare Research and Quality (HS07397), Jacqueline A. Pugh, M.D., and colleagues at the University of Texas Health Sciences Center prospectively studied a random sample of 256 adults with type 2 diabetes seen at five community health centers. They assessed changes in diet and exercise and average blood glucose levels during the previous 8 to 12 weeks at two patient interviews at least 1 year apart.

The researchers also calculated a PCP continuity score, which was independent of the total number of outpatient visits, with the score ranging from 0 (each visit was to a different PCP) to 1 (all visits were to the same PCP). Higher PCP continuity scores were significantly associated with better blood glucose control at followup, even after adjusting for other factors affecting blood glucose level. Patients who improved their diet had a higher continuity score than those who did not improve their diet (0.91 vs. 0.86). Although both groups had an increase in their HbA1c between baseline and followup, those who failed to improve their diets had a significantly larger increase in their HbA1c (0.67 vs. 0.06), suggesting more poorly controlled diabetes.

There was no significant difference in mean continuity scores between those who improved their exercise habits and those who did not improve. Patients were more likely to improve diet management (58 percent) than exercise (35 percent). This finding may reflect the historic emphasis on diet as the key self-management strategy for patients with type 2 diabetes.

The researchers conclude that continuity of care significantly improved glucose control, with a small but significant part of the improvement (8 percent) mediated by improved diet. These findings suggest that a sustained relationship with a doctor may improve patients' glucose control as a result of their willingness to follow the doctor's advice.

For more details, see "Continuity of care, self-management behaviors, and glucose control in patients with type 2 diabetes," by Michael L. Parchman, M.D., Dr. Pugh, Polly Hitchcock Noel, Ph.D., and Anne C. Larme, Ph.D., in Medical Care 40(2), pp. 137-144, 2002.

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