ArticlesContinuity of Care, Self-Management Behaviors, and Glucose Control in Patients With Type 2 DiabetesParchman, Michael L. MD*; Pugh, Jacqueline A. MD†; Noël, Polly Hitchcock PhD†; Larme, Anne C. PhD*Author Information *From the Department of Family and Community Medicine, University of Texas Health Sciences Center-San Antonio, Texas. †VERDICT, a VA Health Services Research Center of Excellence, Audie L. Murphy Division of the South Texas Veterans Health Care System, University of Texas Health Sciences Center-San Antonio, Texas. Supported by a grant from the Texas Diabetes Council and by a grant from the Minority Medical Treatment Effectiveness Program (MEDTEP) of the Agency for Health Care Policy and Research (AHCPR) H507397. Dr. Pugh's and Dr. Noël's salaries were supported in part by the Department of Veterans Affairs. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. Address correspondence and reprint requests to: Michael L. Parchman, MD, Department of Family & Community Medicine, 7703 Floyd Curl Dr. MSC 7795, San Antonio, TX 78229-3900. E-mail: email@example.com Received May 8, 2001; initial review July 5, 2001; October 4, 2001. Medical Care: February 2002 - Volume 40 - Issue 2 - p 137-144 Buy Abstract 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 selfmanagement 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 (HbA1C). 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 HbA1C 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 HbA1C (ttest = –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. © 2002 Lippincott Williams & Wilkins, Inc.