Driving Distance as a Barrier to Glycemic Control in Diabetes

• Published in: Journal of general internal medicine : JGIM Vol. 21; no. 4; pp. 378 - 380
• Main Authors: Strauss, Kaitlin, MacLean, Charles, Troy, Austin, Littenberg, Benjamin
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.04.2006; Springer; Blackwell Science Inc
• Subjects: Adult; Age Factors; Automobile Driving; Biological and medical sciences; Blood Glucose - metabolism; Cross-Sectional Studies; diabetes mellitus; Diabetes Mellitus - drug therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; General aspects; Geographic Information Systems; Glycated Hemoglobin A - analysis; Health Services Accessibility; Humans; Male; Medical sciences; Middle Aged; Miscellaneous; Patient Compliance; Populations at Risk; Primary Health Care; Public health. Hygiene; Public health. Hygiene-occupational medicine; rural health services; Rural Population; Transportation; Vermont; United States; North America; America; Endocrinopathy; Geographic Information Systems; Rural environment; Accessibility; Health; Diabetes mellitus; rural health services; Health service; health services accessibility; Care; transportation; Geographic information system; Sanitary surveillance; Distance; Glycemia; Public health; Inequality
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1111/j.1525-1497.2006.00386.x

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.