This study showed that the number of visits of diabetic patients by a GP plays an important role and desirable effect on controlling blood glucose and HbA1c, and every diabetic patient should be visited at least four times a year by their family physician. According to the authors knowledge this is the first study that evaluates the effect of number of medical care on diabetes control.
Tabrizi et al. in a review found that diabetes management programs with focus on regular visits are significantly related to better control of diabetes, reduced rates of diabetes complications, and reduced hospital admission. Other studies have also shown that improved of delivered care in both clinical and non-clinical areas increases quality of life and personal satisfaction and reduce the disease complications as well as the overall burden of type 2 diabetes.
One of the reasons that patients do not refer to their GP could be relate to quality of health care services. The service should focus on adequate manpower, personal and physical organization, financial resources and the rule of procedure. These factors have a significant relationship with quality of care and patients' satisfaction.
Another reason is related to the effective communication between doctor and patient. Physician – patient communication makes a significant difference to patient health outcomes. Physician education was demonstrated to affect the patients' emotional status, whereas patient education was demonstrated to affect physical health, level of function, blood pressure and blood glucose level. Good communication between physician – could encourage patients refer to the general physician in due time. Despite all been told the exact reason for not referring patient to their GP is not clear and should be studied in further research.
Hypertension and diabetes co-exist frequently resulting in significant mortality and morbidity. The prevalence of hypertension in diabetic patients is 1.5–2 times higher than in general population . Significant increase in mean systolic and diastolic blood pressure in patients during the year of the study may be related to the fact that the physicians who being involved in the program have paid more attention to diagnosis and treatment of diabetes and miss other patients' problems. It is also might be related to macro- and micro-vascular complication of diabetes which makes hypertension treatment more difficult. Despite higher mean blood pressure of the patients in the end of the first year, diastolic and systolic blood pressure of the patients who had received at least four times visits by GPs (appropriate care) were significantly lower than the other patients. This finding emphasizes again the importance of medical care by family physicians. The mean blood pressure was increased in these patients when comparing with their blood pressure at the beginning of the study.
The important issue that needs to be considered in this regard is that when such a specific programs have been implemented and executed, it is also necessary to consider the patients' other health problems, and the health care providers especially GPs should be trained for appropriate management of co-existing problems.
One of the strengths of this study was the large study population which caused greater precision of the results. We also used the least number of medical laboratories possible for testing in order to reduce the variation of test results.
Based on the authors' knowledge there is no previous study to evaluate the relationship between the number of medical visits and blood glucose control in the diabetic patients. Masoudi-Alavia et.al in a Persian study entitled “Effect of design and implementation of health care model in diabetic patients” have declared that in this model, individuals, management system, and social security system are three systems interacting with each others that can cause good glycemic control in diabetic patients. They emphasize the management system as an important component for controlling the disease .
The limitation of the study was that the HbA1c was not measured in diabetic patients in the beginning of the study; therefore we compared the differences in HbA1c in patients who received 1 to 3 visits during a year after diabetes diagnosis with the patients who received at least 4 visits after one year. The patients were assigned in different groups randomly and there were no differences between the different comparison groups of patients.