Seeing a primary-care provider (PCP) every two weeks is the best way for patients with diabetes to achieve target levels of hemoglobin (Hb) A1c, BP and LDL. 


This optimum schedule emerged from the results of a retrospective cohort study of 26,496 primary-care patients with diabetes and elevated measurements in the above-named areas (Arch Intern Med. 2011;171:1542-1550). 


In a comparison of patients who had encounters with their providers every one to two weeks vs. every three to six months: (1) median time to meeting a target HbA1c level of <7.0% was 4.4 months vs. 24.9 months for persons not using insulin, and 10.1 months vs. 52.8 months for insulin users; (2) median time to achieving a BP measurement of <130/85 mm Hg was 1.3 vs. 13.9 months; and (3) median time to LDL levels of <100 mg/dL was 5.1 vs. 32.8 months.


This information comes at a time when 42% of 627 U.S. PCPs believe their patients are receiving too much medical care, according to another report in the same issue of Archives of Internal Medicine (pp. 1582-1585). Only 6% of the respondents felt their patients were receiving too little care.


The most important factors leading them to practice more aggressively were malpractice concerns, clinical performance measures, and having inadequate time to spend with patients. Financial incentives also came into play, with 62% of the clinicians expressing their belief that diagnostic testing would be reduced if it did not generate revenue for medical subspecialists.