Effects of intensified practitioner-patient communication on control of diabetes mellitus

Control of diabetes mellitus requires active participation of patients in self-care and ongoing support from medical professionals. This study examines the hypothesis that control of diabetes can be improved by more frequent communication between patients and medical professionals. We instructed 233 insulin-requiring diabetic patients to mail the results of home blood glucose monitoring to the physician's office at least every two weeks. Feedback from office nurse practitioners followed receipt of these reports, providing frequent two-way communication between regularly scheduled office appointments. In the group of patients who mailed reports more than 26 weeks during the year, the mean glycosylated hemoglobin (GHb) value was 10.4% at baseline, and there was a mean decrease in GHb of 1.0% during the succeeding year (P = .001). In patients who mailed reports less than 26 weeks during the year, mean GHb was 10.2% at baseline, and there was no significant change during the succeeding year. Since mean GHb was virtually identical in the two groups at baseline, mailing the reports of home-determined blood glucose levels and receiving feedback between office visits resulted in improved control of diabetes.