Recommending encounters according to the sociodemographic characteristics of patient strata can reduce risks from type 2 diabetes

Impact of general practitioner appointment frequency on disease management in type 2 diabetes mellitus patients

AIMS

We investigated the association between the frequency of visits to general practitioners (GPs) and the degree of disease control in patients with T2DM.

METHODS

This study included patients diagnosed with T2DM who visited their GPs between 2014 and 2018. A total of 89,674 patients, accounting for 1,203,035 visits, were included. Different clinical features such as glycated hemoglobin (HbA1c%), blood pressure (BP), and c-LDL levels were analyzed. Multifactorial control of T2DM was defined as HbA1c ≤ 7 %, BP ≤ 140/90 mmHg, and LDL cholesterol ≤ 100 mg/dL. Generalized Estimating Equations models were implemented in order to deal with repeated measures for the same patient.

RESULTS

The median age of the patients is 70 years, with 52.8 % being male. An increase in the number of visits per year significantly improves the likelihood of achieving multifactorial diabetes control. Patients with more than 3-visits per year (55.6 %) have a Relative Risks (RR) of 1.258 (95 % Confidence Interval: 1.120-1.414). Frequent visits are associated with better multifactorial control and better c-LDL management. Patients visiting more than 3-times annually tend to achieve better outcomes in multifactorial and c-LDL control.

CONCLUSION

Increasing the frequency of primary care visits significantly enhances multifactorial and cholesterol control among T2DM patients.

Physician-Visit Frequency and Its Impact on Glycemic Control in People With Type 2 Diabetes: Quantifying Care Acceptance Parameters From Retrospective Electronic Health Record Data

OBJECTIVE

 Type 2 diabetes is a metabolic disorder characterized by insulin resistance and hyperglycemia affecting many individuals worldwide. For effective management, adherence to recommended physician visits is important, along with lifestyle modification and pharmacological interventions. Regular doctor visits can improve adherence and help prevent complications. This study examined how doctor-visit frequency impacts blood glucose (BG) control in people with type 2 diabetes.

RESEARCH DESIGN AND METHODS

 This retrospective, single-center study included adults with type 2 diabetes who had at least two visits and two hemoglobin A1c (HbA1c) values recorded at least 90 days apart between March 2019 and November 2023. Visit per quarter ratio (VQR) and the standardized delta HbA1c (ΔHbA1c) were defined. Data were analyzed for descriptive statistics and compared for significance between the groups. Statistical differences among the groups were determined using the Kruskal-Wallis test and Dwass-Steel-Critchlow-Fligner pairwise comparisons.

RESULTS

 Five hundred seventy-seven participants with type 2 diabetes were analyzed, with a mean age of 53.9 years (±12.7). The HbA1c outcome was significantly lower in the good compliance group (7.3%) than in the poor (7.7%). The high VQR group had a significantly lower HbA1c outcome (7.4%) than the low VQR group (7.7%); 50.98% (n = 104) in the low VQR group, 65.54% (n = 97) in the medium VQR group, and 60.44% (n = 136) in the high VQR group achieved HbA1c below the target. The mean ΔHbA1c was significantly lower in the good compliance group compared to the poor compliance group. The average follow-up durations were 11.22 quarters (±4.11) for low VQR, 9.75 quarters (±4.69) for medium VQR, and 5.50 quarters (±4.84) for high VQR.

CONCLUSION

 A higher frequency of follow-up may be needed to encourage people with type 2 diabetes mellitus to visit their doctor regularly. The frequency of doctor visits has a positive impact on BG control. Regular visits enable timely adjustment of therapy and ensure high compliance with prescribed treatment. These findings have significant implications for mitigating nonadherence in chronic conditions like type 2 diabetes mellitus and warrant further investigation.

Optimizing the frequency of physician encounters in follow - up care for patients with type 2 diabetes mellitus: a systematic review

BACKGROUND

Decisions on the frequency of physician encounters for patients with type 2 diabetes mellitus (T2DM) have significant impacts on both patients' health outcomes and burden on health systems, whereas definitive intervals for physician encounters are still lacking in most clinical guidelines. This study systematically reviewed the existing evidence evaluating different frequencies of physician encounters among T2DM patients.

METHODS

Systematic search of studies evaluating different visit frequencies for follow - up care in T2DM patients was performed in MEDLINE Ovid, Embase Ovid, and Cochrane library from database inception to 25 March 2022. Studies on the follow - up encounters driven by non - physicians and those on the episodic visits in the acute care settings were excluded in the screening. Citation searching was conducted via Google Scholar on the identified papers after screening. The risk of bias was assessed using Cochrane RoB2 tool for randomized controlled trials and Newcastle - Ottawa Scale for cohort studies. Findings were summarized narratively.

RESULTS

Among 6363 records from the database search and 231 references from the citation search, 12 articles were eligible for in - depth review. The results showed that for patients who had not achieved cardiometabolic control, intensifying encounter frequency could enhance medication adherence, shorten the time to achieve the treatment target, and improve the patients' quality of life. However, for the patients who had already achieved the treatment targets, less frequent encounters were equivalent to intensive encounters in maintaining their cardiometabolic control, and could save considerable healthcare costs without substantially lowering the quality of care and patients' satisfaction.

CONCLUSION

Existing evidence suggested that the optimal frequency of physician encounters for patients with T2DM should be individualized, which can be stratified by patients' risk levels based on the cardiometabolic control to guide the differential scheduling of physician encounters in the follow - up. More research is needed to determine how to optimize the frequency of physician encounters for this large and heterogeneous population.