The Effect of Changing Regular Care Provider in Type 2 Diabetes Mellitus: A Retrospective Study

Abstract

Introduction: Several studies have demonstrated the benefits of having a regular care provider on the control of chronic diseases. Our study intends to clarify the effects of the transition to a new diabetologist on metabolic control in type 2 diabetes patients followed-upin a tertiary care setting.Material and Methods: Retrospective study performed in an endocrinology outpatient clinic. We randomly selected 50 type 2 diabetespatients for a control group and 50 for a study group. In the study group, we registered the last evaluation before the physician change (year 0) and at the end of each year (year 1, 2 and 3) with the new doctor. Evaluated variables — body mass index, blood pressure, HbA1c and lipid profile — were compared yearly between groups.Results: There was a decrease in mean HbA1c levels (0.4% – 0.5%, p < 0.05) in year 1 and 2 when compared to year 0 in the study group, but not in the control group. This reduction was superior (0.5% – 1.4%, p < 0.05) in patients whose baseline HbA1c was greater than 7%. The other studied variables did not vary significantly throughout follow-up in either group.Discussion: In our study the transition to a different type 2 diabetes physician was associated with a decrease in mean HbA1c and this difference was greater in less well controlled patients.Conclusion: Switching to a new physician may not be harmful and may actually have benefits for the glycemic control of some type 2 diabetes patients.

Effects of continuity of care on health outcomes among patients with diabetes mellitus and/or hypertension: a systematic review

“… , where is the number of attendances to the most frequently visited provider and N is the total number of visits of the patient. Five studies used ‘attendance to a single physician within a period of time’ to define continuity of care [ 30 – 32 , 46 , 50 ], two studies assessed continuity of care based on the location where medical services were provided, rather than on individual physicians [ 48 , 57 ], and three examined both [ 34 , 40 , 52 ]. Explanations for why a certain method was used were rarely provided.…”

“…Continuity of care was reported by six out of seven studies to reduce mortality [ 38 , 39 , 42 , 44 , 45 , 48 , 52 ]. The effect of continuity of care on HbA1c was frequently evaluated in studies focusing on DM patients, but findings were less consistent, with six of the twelve studies showing statistically significant improvements [ 33 , 34 , 36 , 42 , 46 , 51 ]. Continuity of care had little effect on blood pressure, with only two [ 28 , 42 ] out of 13 studies reported improvements [ 25 , 27 , 28 , 30 , 32 , 34 – 36 , 42 , 46 , 50 , 51 , 62 ].…”

“…The effect of continuity of care on HbA1c was frequently evaluated in studies focusing on DM patients, but findings were less consistent, with six of the twelve studies showing statistically significant improvements [ 33 , 34 , 36 , 42 , 46 , 51 ]. Continuity of care had little effect on blood pressure, with only two [ 28 , 42 ] out of 13 studies reported improvements [ 25 , 27 , 28 , 30 , 32 , 34 – 36 , 42 , 46 , 50 , 51 , 62 ]. None of the studies showed any improvement in lipid profile [ 32 , 34 , 36 , 42 , 46 , 51 ] or BMI [ 31 , 35 , 46 ].…”

“…Continuity of care had little effect on blood pressure, with only two [ 28 , 42 ] out of 13 studies reported improvements [ 25 , 27 , 28 , 30 , 32 , 34 – 36 , 42 , 46 , 50 , 51 , 62 ]. None of the studies showed any improvement in lipid profile [ 32 , 34 , 36 , 42 , 46 , 51 ] or BMI [ 31 , 35 , 46 ]. All seven studies that examined the risk of disease-related complications such as cardiovascular disease, end-stage renal disease found that continuity of care reduced complication risks [ 29 , 40 , 47 , 52 – 55 ].…”

“…The reasons behind a lack of significant results among studies in other outcome categories could be due to methodological limitations such as insufficient sample sizes, and use of short-term dynamic outcome measurements. Firstly, studies without significant findings often contained smaller sample sizes [ 25 , 30 – 33 , 36 , 46 , 51 , 62 ]. Having a small or inadequately powered sample size can affect the validity of results and may mask potential associations between continuity of care and study outcomes.…”