Does patient behavior or access factors have the largest influence on screening in type 1 diabetes?

OBJECTIVE Successful disease management is heavily influenced by access to care issues and patient behavior. Screening tests to detect chronic complications are part of diabetes management and may be influenced by access to care or patient decisions. The objective of this research was to examine how strongly access to care and patient behavior predict screening practices. RESEARCH DESIGN AND METHODS Information on screening practices, access to care, and diabetes management were identified from the Pittsburgh Epidemiology of Diabetes Complications Study at two time points: 1998-2001 and 2002-2006. Information on access to care and patient behavior identified in 1998-2001 were examined relative to screening practices observed in 2002-2006. RESULTS Access-to-care issues positively predicted subsequent screening practices. Specifically, specialist care visits, number of doctor visits, and intensive insulin therapy were all strong predictors for screening use. Receipt of the recommended level of screening tests was also positively associated with the patient behavior of daily blood glucose testing. CONCLUSIONS The findings of this study show that access to care, in general, and access to quality diabetes care, in specific, play a key role in the use of recommended screening tests in type 1 diabetic patients. These data suggest that future efforts to improve screening practices in the type 1 diabetic population should address issues related to access to care.