title: Encounter frequency and serum glucose level, blood pressure, and cholesterol level control in patients with diabetes mellitus.
abstract: BACKGROUND
  More frequent patient-provider encounters may lead to faster control of hemoglobin A1c level, blood pressure (BP), and low-density lipoprotein (LDL) cholesterol (LDL-C) level (hereafter referred to as hemoglobin A1c, BP, and LDL-C) and improve outcomes, but no guidelines exist for how frequently patients with diabetes mellitus (DM) should be seen.
  
  
  METHODS
  This retrospective cohort study analyzed 26,496 patients with diabetes and elevated hemoglobin A1c, BP, and/or LDL-C treated by primary care physicians at 2 teaching hospitals between January 1, 2000, and January 1, 2009. The relationship between provider encounter (defined as a note in the medical record) frequency and time to hemoglobin A1c, BP, and LDL-C control was assessed.
  
  
  RESULTS
  Comparing patients who had encounters with their physicians between 1 to 2 weeks vs 3 to 6 months, median time to hemoglobin A1c less than 7.0% was 4.4 vs 24.9 months (not receiving insulin) and 10.1 vs 52.8 months (receiving insulin); median time to BP lower than 130/85 mm Hg was 1.3 vs 13.9 months; and median time to LDL-C less than 100 mg/dL was 5.1 vs 32.8 months, respectively (P<.001 for all). In multivariable analysis, doubling the time between physician encounters led to an increase in median time to hemoglobin A1c (not receiving [35%] and receiving [17%] insulin), BP (87%), and LDL-C (27%) targets (P<.001 for all). Time to control decreased progressively as encounter frequency increased up to once every 2 weeks for most targets, consistent with the pharmacodynamics of the respective medication classes.
  
  
  CONCLUSIONS
  Primary care provider encounters every 2 weeks are associated with fastest achievement of hemoglobin A1c, BP, and LDL-C targets for patients with diabetes mellitus.
authors.affiliation: Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA 02115, USA.
authors.forename: Fritha
authors.initials: F
authors.lastname: Morrison
authors.forename: Maria
authors.initials: M
authors.lastname: Shubina
authors.forename: Alexander
authors.initials: A
authors.lastname: Turchin
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure / Q000502:physiology*; D002784:Cholesterol / Q000097:blood*; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D058007:Physicians, Primary Care; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D002784:Cholesterol; D006442:Glycated Hemoglobin