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Marjorie A. Bowman, MD, MPA; Joseph C. Konen, MD, MSPH
Wake Forest University Winston-Salem, NC

JAMA. 1995;274(20):1584.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—Both Dr Weiner and colleagues¹ and Dr Leape² presume that the standards for diabetes are correct, and therefore that primary care physicians are performing inadequately. We believe that assumption is incorrect. A diabetic patient known to have blood sugars out of control will not benefit from a glycosylated hemoglobin level.

We have studied implementing intensive diabetes education—including medical, nutritional, and exercise components—in primary care practice with disappointing results.³ While knowledge of diabetes, attitudes and skills related to diabetic management, family behaviors, and performance assessments all significantly improved in the experimental group compared with the control group, at final follow-up there were no significant differences in fasting glycemia, glycosylated hemoglobin, or microalbuminuria.

We believe noncompliant patients would be more likely to be in primary care practices than in practices of diabetologists. This difference may account for the findings of Dr Weiner and colleagues.¹ Patients . . . [Full Text PDF of this Article]

Footnotes
Edited by Margaret A. Winker, MD, Senior Editor, and Phil B. Fontanarosa, MD, Senior Editor.

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