Patient adherence improves glycemic control.
The purpose of this study was to assess the influence of appointment keeping and medication adherence on HbA1c.



A retrospective evaluation was performed in 1560 patients with type 2 diabetes who presented for a new visit to the Grady Diabetes Clinic between 1991 and 2001 and returned for a follow-up visit and HbA1c after 1 year of care. Appointment keeping was assessed by the number of scheduled intervening visits that were kept, and medication adherence was assessed by the percentage of visits in which self-reported diabetes medication use was as recommended at the preceding visit.



The patients had an average age of 55 years, body mass index (BMI) of 32 kg/m2, diabetes duration of 4.6 years, and baseline HbA1c of 9.1%. Ninety percent were African American, and 63% were female. Those who kept more intervening appointments had lower HbA1c levels after 12 months of care (7.6% with 6-7 intervening visits vs 9.7% with 0 intervening visits). Better medication adherence was also associated with lower HbA1c levels after 12 months of care (7.8% with 76%-100% adherence). After adjusting for age, gender, race, BMI, diabetes duration, and diabetes therapy in multivariate linear regression analysis, the benefits of appointment keeping and medication adherence remained significant and contributed independently; the HbA1c was 0.12% lower for every additional intervening appointment that was kept (P = .0001) and 0.34% lower for each quartile of better medication adherence (P = .0009).



Keeping more appointments and taking diabetes medications as directed were associated with substantial improvements in HbA1c. Efforts to enhance glycemic outcomes should include emphasis on these simple but critically important aspects of patient adherence.
Rhee
Mary K
MK
The Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Drs Rhee, Ziemer, Cook, El-Kebbi, Gallina, Barnes, Phillips)
Slocum
Wrenn
W
The Strategic National Stockpile Program, Program Preparedness Branch, the Centers for Chronic Disease Control and Health Prevention, Atlanta, Georgia (Mr Slocum)
Ziemer
David C
DC
The Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Drs Rhee, Ziemer, Cook, El-Kebbi, Gallina, Barnes, Phillips)
Culler
Steven D
SD
The Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Culler)
Cook
Curtiss B
CB
The Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Drs Rhee, Ziemer, Cook, El-Kebbi, Gallina, Barnes, Phillips)
El-Kebbi
Imad M
IM
The Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Drs Rhee, Ziemer, Cook, El-Kebbi, Gallina, Barnes, Phillips)
Gallina
Daniel L
DL
The Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Drs Rhee, Ziemer, Cook, El-Kebbi, Gallina, Barnes, Phillips)
Barnes
Catherine
C
The Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Drs Rhee, Ziemer, Cook, El-Kebbi, Gallina, Barnes, Phillips)
Phillips
Lawrence S
LS
The Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Drs Rhee, Ziemer, Cook, El-Kebbi, Gallina, Barnes, Phillips)
D001741:Black or African American / Q000193:education / Q000523:psychology; D000704:Analysis of Variance; D001071:Appointments and Schedules; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000378:metabolism / Q000517:prevention & control* / Q000523:psychology*; D005260:Female; D005845:Georgia; D006442:Glycated Hemoglobin / Q000378:metabolism; D007722:Health Knowledge, Attitudes, Practice; D006773:Hospitals, Municipal; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D010353:Patient Education as Topic / Q000592:standards; D012189:Retrospective Studies; D012648:Self Care / Q000523:psychology; D014505:Urban Population
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents