Continuity of care, self-management behaviors, and glucose control in patients with type 2 diabetes

BACKGROUND. The influence of continuity of care on outcomes of care for patients with type 2 diabetes is poorly understood. OBJECTIVE. To examine the relationships between continuity, glucose control, and advancement through stages of change for self-management behaviors. DESIGN. Prospective cohort study. SETTING. Five community health centers on the Texas-Mexico border. SUBJECTS. A random sample of 256 adults, :18 years of age and older with an established diagnosis of type 2 diabetes. MEASURES. Stage of change for diet and exercise were assessed during two patient interviews, averaging 18.9 months apart. Phlebotomy was performed at each interview to measure glycosolated hemoglobin (HbA,c). Medical records were abstracted for ambulatory care utilization. A continuity score was calculated based on the number of visits and number of providers seen. RESULTS. Patients who advanced one or more stages of change for diet had higher levels of continuity. As continuity improved, the change in HbA,c was smaller. (r = -0.25; P <0.001) This relationship remained significant after controlling for number of visits, months since diagnosis, number of days in the study, duration of diabetes, and advancement in stage of change for diet. Advancement through stage of change for diet explained a significant amount of the variance in the relationship between continuity and HbA(1C) (t test = -11.33; P <0.01). CONCLUSIONS. Continuity of care with a primary care provider is associated with better glucose control among patients with type 2 diabetes. This relationship appears to be mediated by changes in patient behavior regarding diet.