Frequency of outpatient visits for diabetes not associated with glycemic control

The frequency with which patients in a health system were seen for their type 2 diabetes was not correlated with HbA1c levels in a retrospective cohort study comparing several U.S. health care organizations.

The study included patients at nine health care organizations in the High Value Healthcare Collaborative who received care between October 2012 and September 2014. Eligible participants had at least two visits with a type 2 diabetes diagnostic code during any 12-month interval, at least one primary care visit, and a valid HbA1c value at least 12 months before the end of the study period. For each organization, researchers determined the average total ambulatory primary care and endocrinology visits per study participant during the 12 months after the index HbA1c measurement and measured the association between HbA1c level and ambulatory visit frequency. Results were published online on Dec. 2 by the Journal of General Internal Medicine.

Overall, 103,220 adults were included in the study. Organization-specific cohort size ranged from 693 participants at Sinai Health System in New York to 30,973 participants at Baylor Health Care System in Texas. Mayo Clinic in Minnesota had the lowest mean HbA1c level (7.3%), and Hawaii Pacific Health had the greatest proportion of patients whose index HbA1c indicated excellent glucose control (55%). Organizations with higher proportions of patients with low socioeconomic status had the highest mean HbA1c values (8.1% at both Denver Health and Sinai Health System). The unadjusted 12-month visit rate ranged from 2.0 at Mayo Clinic to 5.4 at Hawaii Pacific Health.

After adjustment for age, race, sex, and low socioeconomic status, patients with poor glucose control (10.0% to 10.9%) at Hawaii Pacific Health had, on average, 1.2 more visits per year than those with excellent control (6.0% to 6.9%). Patients with poor glucose control at Baylor Health Care System had, on average, 0.6 additional visit per year than patients with excellent control. For all other organizations, no significant difference was seen in mean visit rates between patients with well-controlled versus poorly controlled diabetes.

Limitations of the study include its sample of nine health systems and the fact that it did not control for certain patient-level or organizational factors that may have confounded the results, the study authors noted.

“To better understand the relationship between visit frequency and care value for patients with type 2 diabetes, future work should include both randomized controlled trials to evaluate optimal visit intervals for patients with diabetes at varying levels of glycemic control as well as comparative effectiveness analyses of strategies other than office visits to care for patients with chronic conditions,” they wrote.