Diabetes care by primary care physicians in Minnesota and Wisconsin

Background. The purpose of this study was to identify the characteristics of diabetes care delivered by primary care physicians. Methods. Twenty-seven primary care physicians recruited through the Minnesota Academy of Family Physicians Research Network and the Wisconsin Research Network recorded a sample of 240 visits for care of patients with diabetes mellitus. Information was collected concerning physician and patient demographics, practice characteristics, and patterns of delivery of diabetes care including referral and clinical outcomes. Results. Seventeen percent of the patients in this study had type I diabetes mellitus; 81% had type II. Fourteen percent of the patients with type I diabetes and 20% of patients with type II were within their target glucose range. Average hemoglobin-A(1c) was 10.0% ± 3.4% and 8.9% ± 2.3% for patients with type I and type II diabetes, respectively (normal, 4.0% to 6.1%). Two distinct patterns of referral existed for patients with newly diagnosed type I diabetes: 44% of physicians rarely referred these patients, whereas 20% almost always referred. Although distance to specialists increased as community size decreased, frequency of referral was not related to practice location. Ninety-five percent of physicians in this study were directly involved in the diabetes education of their patients, and 56% had no certified diabetes educator available. Conclusions. Over the course of this study, patients frequently persisted with treatment regimens that failed to stabilize blood glucose values. With recent evidence that improved glucose control may delay or prevent diabetes complications, it is increasingly important for the primary care physician to optimize available resources to improve glucose control in patients with diabetes in an effort to improve long-term clinical outcomes.