Adherence to clinical guidelines for monitoring diabetes in primary care settings

Objective: Adherence to clinical guidelines is key to improving diabetes care. Contemporary knowledge of guideline adherence is lacking. This study sought to produce a national snapshot of primary care physicians' (PCPs) adherence to the American Diabetes Association guidelines for monitoring diabetes and determine whether continuity of care promotes adherence. Methods: Using the 2013 National Ambulatory Medical Care Survey, we examined adherence to ordering hemoglobin A(1c) (HbA(1c)) and lipid profile tests as recommended by the American Diabetes Association for monitoring diabetes in 2379 primary care visits of patient with diabetes. Results: In the preceding 12 months, less than 60.0% of the patients were given a test recommended for monitoring diabetes (58.0% for HbA(1c) and 57.0% for lipid profile). Continuity of care with PCPs increased the odds of adhering to diabetes monitoring guidelines by 36.0% for the HbA(1c) test (P=0.06) and by 76.0% for the lipid profile test (P=0.0006). Conclusion: A substantial gap exists in achieving optimal monitoring for diabetes in primary care settings in the United States. While PCPs are ideally positioned to ensure that guidelines are closely followed, we found that even in primary care settings, patient-provider continuity of care was associated with guideline adherence.