title: The association of diabetes specialist care with health care practices and glycemic control in patients with type 1 diabetes: a cross-sectional analysis from the Pittsburgh epidemiology of diabetes complications study.
abstract: OBJECTIVE
  To determine whether diabetes care characteristics and glycemic control differ by use of specialist care in a representative cohort of patients with type 1 diabetes.
  
  
  METHODS
  Health care, sociodemographic characteristics, and glycemic control were compared between participants in the Pittsburgh Epidemiology of Diabetes Complications Study who reported receiving specialist care (n = 212) and those who did not (n = 217). Specialist care was defined as having received care from an endocrinologist or diabetologist or diabetes clinic attendance during the last year.
  
  
  RESULTS
  Patients who reported receiving specialist care were more likely to be female, to have an education level beyond high school, to have an annual household income >$20,000, and to have health insurance. Additionally, patients receiving specialist care were more likely to have received diabetes education during the previous 3 years, to have knowledge of HbAlc testing and to have received that test during the previous 6 months, to have knowledge of the Diabetes Control and Complications Trial results, to self-monitor blood glucose, and to inject insulin more than twice daily. A lower HbA1 level was associated with specialist care versus generalist care (9.7 vs. 10.3%; P = 0.0006) as were higher education and income levels. Multivariate analyses suggest that the lower HbA1 levels observed in patients receiving specialist care were restricted to patients with an annual income >$20,000.
  
  
  CONCLUSIONS
  Specialist care was associated with higher levels of participation in diabetes self-care practices and a lower HbA1 level. Future efforts should research and address the failure of patients with low incomes to benefit from specialist care.
authors.affiliation: Department of Medicine, University of Pittsburgh, Pennsylvania, USA. zgiborj@msx.dept-med.pitt.edu
authors.forename: J C
authors.initials: JC
authors.lastname: Zgibor
authors.forename: T J
authors.initials: TJ
authors.lastname: Songer
authors.forename: S F
authors.initials: SF
authors.lastname: Kelsey
authors.forename: J
authors.initials: J
authors.lastname: Weissfeld
authors.forename: A L
authors.initials: AL
authors.lastname: Drash
authors.forename: D
authors.initials: D
authors.lastname: Becker
authors.forename: T J
authors.initials: TJ
authors.lastname: Orchard
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000534:rehabilitation / Q000628:therapy*; D004522:Educational Status; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007182:Income; D008297:Male; D008511:Medicine; D015999:Multivariate Analysis; D010414:Pennsylvania; D012737:Sex Factors; D013038:Specialization
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin