• Kaitlin Strauss, Charles MacLean, Austin Troy, and Benjamin Littenberg.
• College of Medicine, University of Vermont, Burlington, VT 05401, USA. kstrauss@uvm.edu
• J Gen Intern Med. 2006 Apr 1; 21 (4): 378380378-80.

BackgroundDespite advances in treatment of diabetes, many barriers to good glycemic control remain.ObjectiveTo determine the relationship between glycemic control and the driving distance from home to the site of primary care.DesignCross-sectional analysis of data from the Vermont Diabetes Information System.ParticipantsNine-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.MeasurementsHemoglobin 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.ResultsControlling for social, demographic, seasonal, and treatment variables, there was a positive, significant relationship between glycemic control and driving distance (beta=+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 (beta=+0.22%/10 km, P=.016, 95% CI=+0.04, +0.40) than among noninsulin users (beta=+0.06%/10 km, P=.006, 95% CI=+0.02, +0.10).ConclusionLonger 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.

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