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1 Department of Family and Community Medicine, Baylor College of Medicine, Houston, Tex
2 Center for Research Strategies, University of Colorado, Denver, Colo
3 American Academy of Family Physicians, and Department of Sociology, University of Missouri-Kansas City, Kansas City, Mo
4 Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minn
5 Departments of Family Medicine and Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colo
CORRESPONDING AUTHOR: Stephen J. Spann, MD, MBA, Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098-3926, sspann{at}bcm.tmc.edu
PURPOSE 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.
Key Words: Diabetes mellitus, type 2 • primary health care • comorbidity • practice-based research
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