According to a study by investigators at Brigham and Women’s Hospital (BWH) published in the September 26, 2011, issue of Archives of Internal Medicine, high blood glucose, blood pressure and cholesterol levels increase the risk for complications related to diabetes, such as heart attack and stroke, and in order to reduce these risks these values should be reduced to ideal levels. The researchers discovered that frequent meetings between physicians and their patients are linked with treatment goals for blood glucose, blood pressure and cholesterol being achieved faster.

Even though doctors monitor patient’s hemoglobin A1C (a type of blood glucose measurement) levels each three months, current guidelines for diabetes care do not suggest how often physicians should see their patients. These new discoveries might offer a solution, recommending that for those whose diabetes are severely uncontrolled it might be appropriate for physicians to meet with their patients each fortnight.

The team examined the electronic medical records (EMRs) of 26,496 individuals who suffer from type 2 diabetes who had experienced at least one case of high hemoglobin A1C, blood pressure of LDL cholesterol (‘bad’ cholesterol). In the EMR, any note written by the physician was defined as a doctor-patient encounter, including face-to-face meetings and remote encounters like via telephone. All individuals in the investigation were seen by primary care physicians for at least two years from January 2000 to January 2009.

The duration of time it took for high levels of hemoglobin A1C, blood pressure and LDL cholesterol to decrease to reach the the patients treatment goals was analyzed by the team, within this time span they also worked out the average amount of doctor-patient encounters.

In comparison to individuals who saw their physicians every 3-6 months, those who saw their physicians every 1 to 2 weeks reached their treatment goals faster, and their median time to reach their hemoglobin A1C treatment goals were 4.4 months (non-insulin patients) and 10.1months (insulin patients), in comparison to individuals who saw their physicians every three to six months (24.9 months non-insulin patients) and 52.8 months (insulin patients). Those in the 1-2 week group reached their blood pressure levels at 1.3 months compared to 13.9 months of those in the 3-6 month group. Also those in the 1-2 week group reached their LDL cholesterol goal level sooner at 5.1 months in comparison to 32.8 months in the other group. Combined, the average time to reach treatment goals for all values was 1.5 months versus 36.9 months, respectively.

Alexander Turchin, MD, MS, BWH endocrinologist and assistant professor at Harvard Medical School and the investigation’s senior and corresponding author, attributes numerous interactions during doctor-patient encounters for patients reaching target goals.

Turchin explains:

“Physicians may be prescribing new medications or increasing the dose of existing ones. Another process occurring is lifestyle counseling. Physicians are telling patients how they can improve their diet. They are telling their patients to exercise more and lose weight, which is going to help their diabetes control.”

Additional examinations revealed that doubling the duration of time between doctor-patient encounters increased the time it took patients to reach treatment goals. Time to reach hemoglobin A1C goals rose by 35% (non-insulin patients) and 17% (insulin patients). The length of time it took to reach blood pressure and LDL cholesterol goals rose by 87% and 27%, respectively.

This investigation was funded by the Agency for Healthcare Research and Quality, the National library of Medicine and the Diabetes Action Research and Education Foundation.

Written by Grace Rattue