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Primary care, diabetes clinics have low control rates of HbA1c, LDL, microalbuminuria
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While the rates of HbA1c, LDL-cholesterol and microalbuminuria testing appear to be high in both diabetes subspecialty and primary care clinics, the extent of control is substandard for these measures in both settings, according to recent findings.
Moreover, HbA1c control appeared to be better in family practice and internal medicine clinics compared with diabetes clinics, the researchers wrote.
In the retrospective chart review, Ved V. Gossain, MD, FRCP, FACP, FACE, of Michigan State University, and colleagues randomly selected 390 charts of patients with diabetes from family practice (n = 131), internal medicine (n = 134) and diabetes (n = 125) clinics at Michigan State University.
For each clinical setting, the researchers evaluated each of the following diabetic parameters: HbA1c measured, HbA1c controlled (< 7%), blood pressure measured, BP controlled (< 130/80 mmHg, LDL-cholesterol measured, LDL controlled (< 100 mg/dL), microalbumin measured and microalbumin controlled (< 30 mg/g creatinine). The researchers also determined the average age of the patient population, gender distribution, percentage of smokers, type 1 vs. type 2 diabetes and the use of self-monitoring glucose.
The researchers found a higher percentage of patients with type 1 diabetes at the diabetes clinics (34.4%) compared with the family practice (5.3%) and internal medicine (5.2%) clinics. The percentage of patients for whom HbA1c was measured was as follows: 99% in the family practice clinics, 97.8% in the internal medicine clinics and 100% in the diabetes clinics.
Lipid profiles were checked in 97.7% of patients at the family practice clinics, 95.5% in the internal medicine clinics and 92% in the diabetes clinics. In the year prior to an office visit, microalbumin levels were assessed at least once in 85.5% of patients at the family practice clinics, 82.8% in the internal medicine clinics and 76.8% in the diabetes clinics.
The rate of HbA1c control was 38.9% in the family practice clinic, 43.3% in the internal medicine clinic and 28.8% in the diabetes clinic (P = .034). LDL was controlled in 60.3% of patients in the family practice clinic, 64.9% in internal medicine and 64% in the diabetes clinic. Microalbumin was controlled in 60.3% of the patients in family practice, 51.5% in internal medicine and 60% in the diabetes clinic (P = .032). BP control was achieved in 59.5% of patients in family practice, 67.2% in internal medicine and 52.8% in the diabetes clinics.
According to the researchers, the findings regarding HbA1c control do not necessarily indicate equivalence in the level of care provided by diabetes compared with primary care clinics.
“Although HbA1c appeared better in [family medicine] and [internal medicine] clinics compared to [diabetes clinics], the nature of the study precludes the inference that there is no difference between diabetes care provided in a specialty care center vs. a general clinical, although other studies have shown improvement in diabetes parameters with specialist care, but unequivocal evidence of improved mortality is lacking.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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