1. Characteristics of type II diabetics with poor glycemic control who achieve good control. Michal Shani ¹, Tom Taylor ², Shlomo Vinker ¹, Alex Lustman ¹, Rina Erez ¹, Asher Elhayani ¹, Amnon Lahad ³ ¹ Department of Family Medicine, Central District, “ Clalit Health Service ”, Rehovot, Israel. ² Department of Family Medicine, University of Washington, Seattle, Washington USA ³ Department of Family Medicine, Hadassah Medical School, The Hebrew University, Jerusalem, Israel

2. background Access to a primary care physician is universal in Israel. Access to a primary care physician is universal in Israel. “Clalit Health Service” is the largest HMO in Israel serving over 3.5 million people. “Clalit Health Service” is the largest HMO in Israel serving over 3.5 million people. Clalit Health Service is completely computerize for 8 years. The database includes demographics, administration, diagnosis, medications, lab, hospitalizations and costs. Clalit Health Service is completely computerize for 8 years. The database includes demographics, administration, diagnosis, medications, lab, hospitalizations and costs. Data was retrieved from Central district, serving about 500,000 people and over 24,000 diabetics. Data was retrieved from Central district, serving about 500,000 people and over 24,000 diabetics.

3. Background Care of diabetic patients requires many resources, and carries a great economic burden on society. Care of diabetic patients requires many resources, and carries a great economic burden on society. Good glycemic control reduces mortality and long- term complications of diabetes. Good glycemic control reduces mortality and long- term complications of diabetes. Little is known about the predictors that influence changes in glycemic control among poorly controlled diabetic patients. Little is known about the predictors that influence changes in glycemic control among poorly controlled diabetic patients.

4. Objectives To find the characteristics of type II diabetics, who had poor glycemic control in 2001 and achieved good control in 2003, compared to the poorly controlled diabetic patients in 2001 who still had poor glycemic control in 2003 To find the characteristics of type II diabetics, who had poor glycemic control in 2001 and achieved good control in 2003, compared to the poorly controlled diabetic patients in 2001 who still had poor glycemic control in 2003

5. Methods Population: Diabetic patients, 40 years and older, from the Central District of “ Clalit Health Service ”, with at least one HbA1c measure greater than 9.5mg% during 2001. Population: Diabetic patients, 40 years and older, from the Central District of “ Clalit Health Service ”, with at least one HbA1c measure greater than 9.5mg% during 2001. They were divided into two categories according to their last HbA1c levels in 2003, well controlled (HbA1c 9.5mg%). They were divided into two categories according to their last HbA1c levels in 2003, well controlled (HbA1c 9.5mg%).

6. Results 2,962 patients were included in the study. 1,232 patients were considered well controlled, 1,730 were considered poorly controlled. 2,962 patients were included in the study. 1,232 patients were considered well controlled, 1,730 were considered poorly controlled. 1567 (52.9%) were female. 1567 (52.9%) were female. The average was age 63.9 years. The average was age 63.9 years. 1098 (37%) were of low socioeconomic status. 1098 (37%) were of low socioeconomic status. 249 primary care physicians took care of these patients. 249 primary care physicians took care of these patients.

7. Patient ’ s characteristics and good glycemic control Men were more likely than women to become well controlled (52% vs. 43.6% p< 0.001). Men were more likely than women to become well controlled (52% vs. 43.6% p< 0.001). The average age of those who became well controlled was slightly younger than for those who were poorly controlled 63.2 vs. 64.5 (p<0.001) The average age of those who became well controlled was slightly younger than for those who were poorly controlled 63.2 vs. 64.5 (p<0.001) There were less patients from low socioeconomic status in the well controlled group as compared to the poorly controlled group. There were less patients from low socioeconomic status in the well controlled group as compared to the poorly controlled group.

8. Primary care physician and good glycemic control The primary care physician was the most significant predictor of good glycemic control. The primary care physician was the most significant predictor of good glycemic control. None of the primary care physician characteristics were related to glycemic control, beside being a clinic director. None of the primary care physician characteristics were related to glycemic control, beside being a clinic director.

9. Patients ’ costs and good glycemic control There were no differences in patient ’ s hospitalizations, average drug cost or average total cost between the two groups in 2001. There were no differences in patient ’ s hospitalizations, average drug cost or average total cost between the two groups in 2001. A higher percentage of patients in the poorly controlled group were hospitalized during 2004 ¹ (34.9% vs. 31.1% p=0.004). A higher percentage of patients in the poorly controlled group were hospitalized during 2004 ¹ (34.9% vs. 31.1% p=0.004). The average patient cost was 8% lower in 2004 ¹ in the well controlled group compared to the poorly controlled group. The average patient cost was 8% lower in 2004 ¹ in the well controlled group compared to the poorly controlled group.

10. Conclusions The primary care physician was the strongest predictor of achieving good control. The primary care physician was the strongest predictor of achieving good control. Good glycemic control was related to hospitalization and cost reduction. Good glycemic control was related to hospitalization and cost reduction.

11. Conclusions Investing in primary care physician empowerment in order to improve glycemic control could be an effective way to improve health and to reduce costs. Investing in primary care physician empowerment in order to improve glycemic control could be an effective way to improve health and to reduce costs.