Abstract
To improve the health of people with diabetes, it is essential to identify why patients experience extended periods of poor glycemic control before therapeutic intensification. We surveyed 252 primary care providers at Kaiser Permanente Northwest to determine their beliefs about the glycemic goals of their patients, treatment intensification behavior, and barriers to achieving optimal glycemic control. We linked the responses of 149 providers to the health records of their 18 346 patients with diabetes. Patient glycemic levels were not related to either individualized glycemic goals or provider intensification behavior. Providers' beliefs about diabetic treatment and glycated hemoglobin (HbA1c) goals were poorly associated with patient HbA1c levels. Providers identified patients' resistance to lifestyle behaviors and taking insulin, lack of medication adherence, and psychosocial issues as the main barriers to optimal glycemic control. Lack of time to care for complex patients was also a barrier. Providers who agreed that "current research did not support A1C levels <7%" were less likely to have patients with HbA1c levels <7% (OR=0.87, 95% CI 0.78 to 0.97) and patients of providers who disagreed that "some patients will have an ...Continue Reading
References
Nov 6, 2001·Annals of Internal Medicine·L S PhillipsC S Barnes
Feb 27, 2004·Diabetic Medicine : a Journal of the British Diabetic Association·R W GrantJ B Meigs
Jun 29, 2004·Diabetes Care·Jonathan B BrownAndrew Perry
Mar 1, 2005·Diabetes Care·Baiju R ShahCarl van Walraven
Aug 16, 2005·The Diabetes Educator·David C ZiemerLawrence S Phillips
Sep 24, 2005·Diabetic Medicine : a Journal of the British Diabetic Association·M PeyrotS E Skovlund
Mar 16, 2007·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·Gregory A NicholsJonathan B Brown
Jun 6, 2007·Annals of Family Medicine·Michael L ParchmanKrista W Bowers
Oct 24, 2008·Diabetes Care·David M NathanUNKNOWN European Association for Study of Diabetes
May 2, 2009·Diabetes Care·Alexander R Cobitz, Phil Ambery
Dec 31, 2009·Diabetes Care·Jonathan B BrownGregory A Nichols
Jul 28, 2010·Current Medical Research and Opinion·Gregory A NicholsJonathan B Brown
Sep 29, 2011·Archives of Internal Medicine·Fritha MorrisonAlexander Turchin
Jan 4, 2012·Diabetes & Metabolism·Alan J SinclairUNKNOWN European Diabetes Working Party for Older People
Jan 27, 2012·Diabetes Care·Gregory A NicholsKimberly G Brodovicz
Feb 9, 2012·Annals of Internal Medicine·Amir QaseemUNKNOWN Clinical Guidelines Committee of the American College of Physicians
Oct 27, 2012·Diabetes Care·M Sue KirkmanCarrie S Swift
Jan 4, 2013·Diabetes Care·UNKNOWN American Diabetes Association
Jan 1, 2013·Diabetes Research and Clinical Practice·Mark PeyrotSøren E Skovlund
Feb 19, 2013·Diabetes Care·Sarah Stark CasagrandeCatherine C Cowie
Apr 20, 2013·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·Alan J GarberUNKNOWN American Association of Clinical Endocrinologists
Jul 24, 2013·Diabetes Care·Kamlesh KhuntiMelanie J Davies
Aug 24, 2013·The American Journal of Medicine·Stuart A Ross
Feb 8, 2014·Diabetes Research and Clinical Practice·Carrie McAdam-MarxDiana I Brixner
Citations
Sep 13, 2016·Diabetes Research and Clinical Practice·Mehul R DalalNella Bieszk
Nov 30, 2016·Journal of Diabetes Science and Technology·Oliver SchnellJianping Weng
May 4, 2017·Diabetes & Vascular Disease Research : Official Journal of the International Society of Diabetes and Vascular Disease·Lawrence BlondeUNKNOWN Global Partnership for Effective Diabetes Management
Jan 26, 2018·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·Matthew F BouchonvilleSanjeev Arora
Aug 18, 2020·Cardiovascular Endocrinology & Metabolism·Dennis Bruemmer, Steven E Nissen
Dec 9, 2020·Journal of Primary Care & Community Health·Maher R KhdourDoaa H Al-Hamed
Aug 8, 2021·Diabetes Therapy : Research, Treatment and Education of Diabetes and Related Disorders·Ayman A Al HayekMohamed A Al Dawish