Management of type 2 diabetes in the primary care setting: a practice-based research network study.
OBJECTIVE
We wanted to describe how primary care clinicians care for patients with type 2 diabetes.


METHODS
We undertook a cross-sectional study of 95 primary care clinicians and 822 of their established patients with type 2 diabetes from 4 practice-based, primary care research networks in the United States. Clinicians were surveyed about their training and practice. Patients completed a self-administered questionnaire about their care, and medical records were reviewed for complications, treatment, and diabetes-control indicators.


RESULTS
Participating clinicians (average age, 45.7 years) saw an average of 32.6 adult patients with diabetes per month. Patients (average age, 59.7 years) reported a mean duration of diabetes of 9.1 years, with 34.3% having had the disease more than 10 years. Nearly one half (47.5%) of the patients had at least 1 diabetes-related complication, and 60.8% reported a body mass index greater than 30. Mean glycosylated hemoglobin (HbA1c) level was 7.6% (SD 1.73), and 40.5% of patients had values <7%. Only 35.3% of patients had adequate blood pressure control (<130/85 mm Hg), and only 43.7% had low-density lipoprotein cholesterol (LDL-C) levels <100 mg/dL. Only 7.0% of patients met all 3 control targets. Multilevel models showed that patient ethnicity, practice type, involvement of midlevel clinicians, and treatment were associated with HbA1c level; patient age, education level, and practice type were associated with blood pressure control; and patient ethnicity was associated with LDL-C control.


CONCLUSIONS
Only modest numbers of patients achieve established targets of diabetes control. Reengineering primary care practice may be necessary to substantially improve care.
Spann
Stephen J
SJ
Department of Family and Community Medicine, Baylor College of Medicine, Houston, Tex 77098-3926, USA. sspann@bcm.tmc.edu
Nutting
Paul A
PA
Galliher
James M
JM
Peterson
Kevin A
KA
Pavlik
Valory N
VN
Dickinson
L Miriam
LM
Volk
Robert J
RJ
D002318:Cardiovascular Diseases; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D005194:Family Practice; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006302:Health Services Research; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care; D012044:Regression Analysis; D012307:Risk Factors; D011795:Surveys and Questionnaires
D006442:Glycated Hemoglobin