Abstract
BackgroundAlthough most diabetic patients do not achieve good physiologic control, patients who live closer to their source of primary care tend to have better glycemic control than those who live farther away. We sought to assess the role of travel burden as a barrier to the use of insulin in adults with diabetesMethods781 adults receiving primary care for type 2 diabetes were recruited from the Vermont Diabetes Information System. They completed postal surveys and were interviewed at home. Travel burden was estimated as the shortest possible driving distance from the patient's home to the site of primary care. Medication use, age, sex, race, marital status, education, health insurance, duration of diabetes, and frequency of care were self-reported. Body mass index was measured by a trained field interviewer. Glycemic control was measured by the glycosolated hemoglobin A1C assay.ResultsDriving distance was significantly associated with insulin use, controlling for the covariates and potential confounders. The odds ratio for using insulin associated with each kilometer of driving distance was 0.97 (95% confidence interval 0.95, 0.99; P = 0.01). The odds ratio for using insulin for those living within 10 km (compared to those with greater driving distances) was 2.29 (1.35, 3.88; P = 0.02).DiscussionAdults with type 2 diabetes who live farther from their source of primary care are significantly less likely to use insulin. This association is not due to confounding by age, sex, race, education, income, health insurance, body mass index, duration of diabetes, use of oral agents, glycemic control, or frequency of care, and may be responsible for the poorer physiologic control noted among patients with greater travel burdens.
Highlights
Most diabetic patients do not achieve good physiologic control, patients who live closer to their source of primary care tend to have better glycemic control than those who live farther away
We examined the relationship between insulin usage and the driving distance from a patient's home to their site of primary care
Description of population The analysis included 781 patients from 68 practices who completed the interview without missing values for any of the covariates, had an address that could be geographically referenced, and did not meet criteria for type 1 diabetes
Summary
Most diabetic patients do not achieve good physiologic control, patients who live closer to their source of primary care tend to have better glycemic control than those who live farther away. We sought to assess the role of travel burden as a barrier to the use of insulin in adults with diabetes. In spite of the widespread availability of efficacious therapies, adequate management of diabetes remains an elusive goal [1,2]. Barriers to optimum control of diabetes in community settings include poor practice management and organization [3,4,5], poor adherence to medical advice (page number not for citation purposes). Appropriate use of insulin can lead to better glycemic control, as well as a better selfreported quality of life [9], many patients and providers underutilize insulin for a variety of reasons, including clinical inertia [10] and medical concerns [11]. Americans are more likely to be disabled in certain parts of the country than others [14,15]
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