Pediatric diabetes management in Appalachian Kentucky: adherence of primary care physicians to ADA guidelines.

OBJECTIVE: The prevalence of diabetes mellitus in Eastern Kentucky is estimated at nearly three times the national average. Unfortunately, Eastern Kentucky's Appalachian region also faces poverty levels of at least twice the national average, a factor which could adversely affect the ability of families of pediatric diabetic patients in this region to access remote pediatric diabetes subspecialty programs. Therefore, the objective of this study was to survey current pediatric diabetes practice standards among Eastern Kentucky's primary care physicians and compare them to guidelines for diabetes management set forth by the American Diabetes Association (ADA). RESEARCH DESIGN AND METHODS: Surveys were sent to 402 primary care physicians practicing in 25 Kentucky counties designated as rural by the Appalachian Regional Commission (ARC). Information was sought to determine the frequency of diabetes-related office visits, recommendations for glucose monitoring, typically prescribed insulin regimens, monitoring of diabetes-related complications, and the availability of diabetes-care support staff. RESULTS: It was found that the majority of primary care physicians in this region met ADA guidelines for frequent follow-up evaluation of diabetes. However, they generally did not meet ADA guidelines for intensive management of diabetes by typically recommending self blood-glucose monitoring < or = 2 times/day, the use of < or = 2 insulin injections/day to maintain glycemic control, and inconsistent screening for the occurrence of diabetes-related complications. CONCLUSIONS: These results support the need for further medical education of primary care physicians in Eastern Kentucky in the management of children with Type 1 diabetes.