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Open Access Research article

The use of insulin declines as patients live farther from their source of care: results of a survey of adults with type 2 diabetes

Benjamin Littenberg12*, Kaitlin Strauss1, Charles D MacLean1 and Austin R Troy3

Author Affiliations

1 Division of General Internal Medicine, University of Vermont, Burlington, Vermont, USA

2 College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA

3 Rubenstein School of Natural Resources, University of Vermont, Burlington, Vermont, USA

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BMC Public Health 2006, 6:198  doi:10.1186/1471-2458-6-198

Published: 27 July 2006

Abstract

Background

Although 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

Methods

781 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.

Results

Driving 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).

Discussion

Adults 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.