The Impact of Visit Frequency and Treatment Intensification on Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Two-Year Retrospective Cohort Study from a Private Clinic

Abstract

Background: Diabetes mellitus is a chronic illness that needs ongoing care to prevent complications from developing and to treat them when they do. Blood glucose levels should ideally be kept close to normal (HbA1c <7%). The ADA's Standards of Care in Diabetes—2025 supports less stringent HbA1c targets for older adults. One of the most prevalent non-communicable diseases in our area is diabetes. Due to easier access to doctors, drugs, and lab testing, the majority of people seek care in private clinics or hospitals. This puts financial strain on patients, decreasing their adherence to clinic appointments and limiting their capacity to pay for more intensive treatment, which also poses a problem for doctors. Objectives: This study aims to find the association between clinic visit frequency, treatment intensification, and glycemic outcomes in private clinic settings. Materials and Methods: This is a retrospective cohort study conducted in our private clinic, Slemani, Kurdistan Region, Iraq, between 01 January 2023 to 01 January 2025. Treatment intensification is defined as when the addition of a new antidiabetic drug class starts for better HbA1c control. Visit frequency is defined as "adequate" when follow-up was at least 4 visits / 2 years. Results: A total of 617 patients were screened who attended the clinic during the period of the study between 01 January 2023 to 01 January 2025. Out of this, only 221 patients fulfilled the inclusion criteria. During follow-up, 194 patients (87.7%) underwent treatment intensification. Treatment intensification was significantly associated with final HbA1c (p < 0.001), demonstrating that it is an important predictor of glycemic outcomes in this cohort. In contrast, visit frequency was not statistically significant (p = 0.803), indicating that the number of visits alone did not significantly influence final HbA1c levels. Conclusion: In this cohort, the frequency of clinic visits during the follow-up period was not significantly associated with achieving the target HbA1c level. This may suggest that the number of visits alone is insufficient to improve glycemic control without effective therapeutic interventions or patient engagement. In contrast, treatment intensification showed a significant association with achieving HbA1c targets.