Skip to main content

Advertisement

SpringerLink
Log in

Driving distance as a barrier to glycemic control in diabetes

  • Populations At Risk
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND: Despite advances in treatment of diabetes, many barriers to good glycemic control remain.

OBJECTIVE: To determine the relationship between glycemic control and the driving distance from home to the site of primary care.

DESIGN: Cross-sectional analysis of data from the Vermont Diabetes Information System.

PARTICIPANTS: Nine-hundred and seventy-three adults with diabetes in primary care. The mean age was 64.9 years, 57% were female, and 18.4% used insulin.

MEASUREMENTS: Hemoglobin A1c, shortest driving distance from a patient’s home to the site of primary care calculated by geographic software, self-reported gender, age, education, income, marital status, race, insurance coverage, diabetic complications, and use of insulin and oral hypoglycemic agents.

RESULTS: Controlling for social, demographic, seasonal, and treatment variables, there was a positive, significant relationship between glycemic control and driving distance (β=+0.07%/10 km, P<.001, 95% confidence interval [CI]=+0.03, +0.11). Driving distance had a stronger association with glycemic control among insulin users (β=+0.22%/10 km, P=.016, 95% CI=+0.04, +0.40) than among noninsulin users (β=+0.06%/10 km, P=.006, 95% CI=+0.02, +0.10).

CONCLUSION: Longer driving distances from home to the site of primary care were associated with poorer glycemic control in this population of older, rural subjects. While the mechanism for this effect is not known, providers should be aware of this potential barrier to good glycemic control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Saaddine JB, Engelgau MM, Beckles GL, Gregg EW, Thompson TJ, Narayan KM. A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med. 2002;136:565–74.

    PubMed  Google Scholar 

  2. Saydah SH, Fradkin J, Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA. 2004;291:335–42.

    Article  CAS  PubMed  Google Scholar 

  3. Frame PS. Health maintenance in clinical practice: strategies and barriers. Am Fam Physician. 1992;45:1192–200.

    CAS  PubMed  Google Scholar 

  4. Stolar MW. Clinical management of the NIDDM patient. Impact of the American Diabetes Association practice guidelines, 1985–1993. Endocrine Fellows Foundation Study Group. Diabetes Care. 1995;18:701–7.

    Article  CAS  PubMed  Google Scholar 

  5. Cabana MD, Rand CS, Powe NR, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458–65.

    Article  CAS  PubMed  Google Scholar 

  6. Warren L, Hixenbaugh P. Adherence and diabetes. In: Meyers LB, Midence K, eds. Adherence to Treatment in Medical Conditions. Amsterdam: Harwood; 1998:423–53.

    Google Scholar 

  7. Williams MV, Parker RM, Baker DW, et al. Inadequate functional health literacy among patients at two public hospitals. JAMA. 1995;274:1677–82.

    Article  CAS  PubMed  Google Scholar 

  8. Schillinger D, Grumbach K, Piette J, et al. Association of health literacy with diabetes outcomes. JAMA. 2002;288:475–82.

    Article  PubMed  Google Scholar 

  9. Goel A, MacLean CD, Walrath D, et al. Adapting root cause analysis to chronic medical conditions. Jt Comm J Qual Saf. 2004;30:175–86.

    PubMed  Google Scholar 

  10. Harris MI. Health care and health status and outcomes for patients with type 2 diabetes. Diabetes Care. 2000;23:754–8.

    Article  CAS  PubMed  Google Scholar 

  11. Hegney D, Pearce S, Rogers-Clark C, Martin-McDonald K, Buikstra E. Close, but still too far. The experience of Australian people with cancer commuting from a regional to a capital city for radiotherapy treatment. Eur J Cancer Care. 2005;14:75–82.

    Article  CAS  Google Scholar 

  12. Borders TF, Rohrer JE, Hilsenrath PE, Ward MM. Why rural residents migrate for family physician care. J Rural Health. 2000;16:337–48.

    Article  CAS  PubMed  Google Scholar 

  13. Arcury TA, Preisser JS, Gesler WM, Powers JM. Access to transportation and health care utilization in a rural region. J Rural Health. 2005;21:31–8.

    Article  PubMed  Google Scholar 

  14. MacLean CD, Littenberg B, Gagnon M, Reardon M, Turner PW, Jordan C. The Vermont Diabetes Information System (VDIS): study design and subject recruitment for a cluster randomized trial of a decision support system in a regional sample of primary care practices. Clin Trials. 2004;1:523–44.

    Article  Google Scholar 

  15. Cuzick J. A Wilcoxon-type test for trend. Stat Med. 1985;4:87–90.

    Article  CAS  PubMed  Google Scholar 

  16. Hamilton L. How robust is regression? Stata Tech Bull. 1991;2:21–6.

    Google Scholar 

  17. Tseng CL, Brimacombe M, Xie M, et al. Seasonal patterns in monthly hemoglobin A1c values. Am J Epidemiol. 2005;161:565–74.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Rubenstein School of Natural Resources, University of Vermont, Burlington, VT, USA

    Austin Troy PhD

  2. College of Medicine, University of Vermont, 371 Pearl St, 05401, Burlington, VT

    Kaitlin Strauss BA, Charles MacLean MDCM & Benjamin Littenberg MD

Authors
  1. Kaitlin Strauss BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Charles MacLean MDCM
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Austin Troy PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Benjamin Littenberg MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kaitlin Strauss BA.

Additional information

The authors have no conflicts of interest to declare.

This work was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK61167 and K24 DK068380).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Strauss, K., MacLean, C., Troy, A. et al. Driving distance as a barrier to glycemic control in diabetes. J Gen Intern Med 21, 378–380 (2006). https://doi.org/10.1111/j.1525-1497.2006.00386.x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00386.x

Key words

Search

Navigation