Characteristics of Diabetics with Poor Glycemic Control
Characteristics of Diabetics with Poor Glycemic Control
Objective: To find the characteristics of diabetics with poorly controlled diabetes that became well controlled compared with the patients with poorly controlled diabetes that remained poorly controlled.
Methods: The sample included diabetic patients, aged 40 years and older, from the Central district of Clalit Health Service in Israel, with at least one HbA1c measure greater than 9.5 mg% during 2001. They were divided into 2 categories according to their HbA1c levels in 2003, well controlled (HbA1c <7.5 mg%) and poorly controlled (HbA1c >9.5 mg%). Patients with 7.5< HbA1c <9.5 in 2003 were excluded from analysis.
Results: Two thousand sixty-two diabetic patients met the inclusion criteria and care was provided by one of 249 primary care physicians. Of these patients, 1232 (41.6%) had well-controlled diabetes and 1760 (58.4%) had poorly controlled diabetes in 2003. The well-controlled group had fewer patients with low socioeconomic status (30.3% vs 41.9%; P < .001) and more men (52% vs 43.8%; P < .001). The individual primary care physician was the most significant predictor of good glycemic control. Total patient costs in 2004 were 8% lower among the group with well-controlled diabetes.
Conclusion: The primary care physician has an important role in the patient's chances of achieving glycemic control. Further investigation of how and why some primary care physicians achieve better diabetes control in their patients would be worthwhile.
Care of diabetic patients requires many resources and places a great economic burden on society. The prevalence of diabetes among Israeli adults in 1998 was 6.1 of 100 and the prevalence of diabetes among the Israeli general population in 2000 was 3.4 of 100. According to the Israeli Diabetes Association, this accounts for approximately 250,000 patients nationwide. It has been estimated that 10% of diabetic patients in Israel are undiagnosed, so the actual number of diabetic patients is most likely higher.
Good glycemic control reduces mortality and long-term complications of diabetes. Predictors such as medication adherence, physical activity, family support, and coping mechanisms have been correlated with diabetic control.
Little is known about the predictors that influence changes in glycemic control among patients with poorly controlled diabetes. We used the computerized database of Clalit Health Service (CHS) to identify characteristics that were associated with improvements in diabetic control.
Defining the characteristics of patients with poorly controlled diabetes that became well controlled may reveal new predictors related to achieving good glycemic control. This information will help with planning better intervention programs for diabetic patients in the future.
CHS is the largest health maintenance organization (HMO) in Israel, serving over 50% of the Israeli population. Patient records have been completely computerized for over 8 years. The CHS central database includes demographic data, working diagnoses, laboratory results, and administrative data relating to the primary care physician, primary care clinic, and costs. CHS Central district serves approximately 500,000 patients from all socioeconomic levels. Over 24,000 diabetic patients are registered in the district database. The working diagnosis of "diabetes mellitus" detects over 90% of the known diabetics.
Access to a primary care physician is universal in Israel. Every person insured by CHS is assigned to a primary care physician. The primary care physician is responsible for all routine follow-ups, including diabetic care. There are no copayments for any procedure within the primary care clinic, including primary care physician visits. There is a very small copayment (approximately US$3) for an ophthalmologic check up. Each primary care clinic is managed by a primary care physician who is one of the clinic staff.
This descriptive study follows the care of diabetic patients within their primary care setting while receiving their usual care. The objective was to define the characteristics of diabetics who had poor glycemic control in 2001 and achieved good control by 2003 compared with the patients with poor glycemic control in 2001 who still had poor glycemic control in 2003.
Abstract and Introduction
Abstract
Objective: To find the characteristics of diabetics with poorly controlled diabetes that became well controlled compared with the patients with poorly controlled diabetes that remained poorly controlled.
Methods: The sample included diabetic patients, aged 40 years and older, from the Central district of Clalit Health Service in Israel, with at least one HbA1c measure greater than 9.5 mg% during 2001. They were divided into 2 categories according to their HbA1c levels in 2003, well controlled (HbA1c <7.5 mg%) and poorly controlled (HbA1c >9.5 mg%). Patients with 7.5< HbA1c <9.5 in 2003 were excluded from analysis.
Results: Two thousand sixty-two diabetic patients met the inclusion criteria and care was provided by one of 249 primary care physicians. Of these patients, 1232 (41.6%) had well-controlled diabetes and 1760 (58.4%) had poorly controlled diabetes in 2003. The well-controlled group had fewer patients with low socioeconomic status (30.3% vs 41.9%; P < .001) and more men (52% vs 43.8%; P < .001). The individual primary care physician was the most significant predictor of good glycemic control. Total patient costs in 2004 were 8% lower among the group with well-controlled diabetes.
Conclusion: The primary care physician has an important role in the patient's chances of achieving glycemic control. Further investigation of how and why some primary care physicians achieve better diabetes control in their patients would be worthwhile.
Introduction
Care of diabetic patients requires many resources and places a great economic burden on society. The prevalence of diabetes among Israeli adults in 1998 was 6.1 of 100 and the prevalence of diabetes among the Israeli general population in 2000 was 3.4 of 100. According to the Israeli Diabetes Association, this accounts for approximately 250,000 patients nationwide. It has been estimated that 10% of diabetic patients in Israel are undiagnosed, so the actual number of diabetic patients is most likely higher.
Good glycemic control reduces mortality and long-term complications of diabetes. Predictors such as medication adherence, physical activity, family support, and coping mechanisms have been correlated with diabetic control.
Little is known about the predictors that influence changes in glycemic control among patients with poorly controlled diabetes. We used the computerized database of Clalit Health Service (CHS) to identify characteristics that were associated with improvements in diabetic control.
Defining the characteristics of patients with poorly controlled diabetes that became well controlled may reveal new predictors related to achieving good glycemic control. This information will help with planning better intervention programs for diabetic patients in the future.
CHS is the largest health maintenance organization (HMO) in Israel, serving over 50% of the Israeli population. Patient records have been completely computerized for over 8 years. The CHS central database includes demographic data, working diagnoses, laboratory results, and administrative data relating to the primary care physician, primary care clinic, and costs. CHS Central district serves approximately 500,000 patients from all socioeconomic levels. Over 24,000 diabetic patients are registered in the district database. The working diagnosis of "diabetes mellitus" detects over 90% of the known diabetics.
Access to a primary care physician is universal in Israel. Every person insured by CHS is assigned to a primary care physician. The primary care physician is responsible for all routine follow-ups, including diabetic care. There are no copayments for any procedure within the primary care clinic, including primary care physician visits. There is a very small copayment (approximately US$3) for an ophthalmologic check up. Each primary care clinic is managed by a primary care physician who is one of the clinic staff.
This descriptive study follows the care of diabetic patients within their primary care setting while receiving their usual care. The objective was to define the characteristics of diabetics who had poor glycemic control in 2001 and achieved good control by 2003 compared with the patients with poor glycemic control in 2001 who still had poor glycemic control in 2003.