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Journal Article

Citation

Strauss K, MacLean C, Troy A, Littenberg B. J. Gen. Intern Med. 2006; 21(4): 378-380.

Affiliation

College of Medicine, University of Vermont, Burlington, VT 05401, USA. kstrauss@uvm.edu

Comment In:

J Gen Intern Med 2006;21(9):1008; author reply 1008

Copyright

(Copyright © 2006, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1111/j.1525-1497.2006.00386.x

PMID

16686817

PMCID

PMC1484707

Abstract

BACKGROUND: Despite advances in treatment of diabetes, many barriers to good glycemic control remain. OBJECTIVE: To determine the relationship between glycemic control and the driving distance from home to the site of primary care. DESIGN: Cross-sectional analysis of data from the Vermont Diabetes Information System. PARTICIPANTS: Nine-hundred and seventy-three adults with diabetes in primary care. The mean age was 64.9 years, 57% were female, and 18.4% used insulin. MEASUREMENTS: Hemoglobin A1c, shortest driving distance from a patient's home to the site of primary care calculated by geographic software, self-reported gender, age, education, income, marital status, race, insurance coverage, diabetic complications, and use of insulin and oral hypoglycemic agents. RESULTS: Controlling for social, demographic, seasonal, and treatment variables, there was a positive, significant relationship between glycemic control and driving distance (beta=+0.07%/10 km, P<.001, 95% confidence interval CI=+0.03, +0.11). Driving distance had a stronger association with glycemic control among insulin users (beta=+0.22%/10 km, P=.016, 95% CI=+0.04, +0.40) than among noninsulin users (beta=+0.06%/10 km, P=.006, 95% CI=+0.02, +0.10). CONCLUSION: Longer driving distances from home to the site of primary care were associated with poorer glycemic control in this population of older, rural subjects. While the mechanism for this effect is not known, providers should be aware of this potential barrier to good glycemic control.


Language: en

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