title: Driving distance as a barrier to glycemic control in diabetes.
abstract: BACKGROUND
  Despite advances in treatment of diabetes, many barriers to good glycemic control remain.
  
  
  OBJECTIVE
  To determine the relationship between glycemic control and the driving distance from home to the site of primary care.
  
  
  METHODS
  Cross-sectional analysis of data from the Vermont Diabetes Information System.
  
  
  METHODS
  Nine-hundred and seventy-three adults with diabetes in primary care. The mean age was 64.9 years, 57% were female, and 18.4% used insulin.
  
  
  METHODS
  Hemoglobin A1c, shortest driving distance from a patient's home to the site of primary care calculated by geographic software, self-reported gender, age, education, income, marital status, race, insurance coverage, diabetic complications, and use of insulin and oral hypoglycemic agents.
  
  
  RESULTS
  Controlling for social, demographic, seasonal, and treatment variables, there was a positive, significant relationship between glycemic control and driving distance (beta=+0.07%/10 km, P<.001, 95% confidence interval [CI]=+0.03, +0.11). Driving distance had a stronger association with glycemic control among insulin users (beta=+0.22%/10 km, P=.016, 95% CI=+0.04, +0.40) than among noninsulin users (beta=+0.06%/10 km, P=.006, 95% CI=+0.02, +0.10).
  
  
  CONCLUSIONS
  Longer driving distances from home to the site of primary care were associated with poorer glycemic control in this population of older, rural subjects. While the mechanism for this effect is not known, providers should be aware of this potential barrier to good glycemic control.
authors: College of Medicine, University of Vermont, Burlington, VT 05401, USA. kstrauss@uvm.edu
authors: Kaitlin
authors: K
authors: Strauss
authors: Charles
authors: C
authors: MacLean
authors: Austin
authors: A
authors: Troy
authors: Benjamin
authors: B
authors: Littenberg