Objective Adherence to clinical guidelines is key to improving diabetes care. Contemporary knowledge of guideline adherence is lacking. This study sought to produce a national snapshot of primary care physicians’ (PCPs) adherence to the American Diabetes Association guidelines for monitoring diabetes and determine whether continuity of care promotes adherence.

Methods Using the 2013 National Ambulatory Medical Care Survey, we examined adherence to ordering hemoglobin A_1c (HbA_1c) and lipid profile tests as recommended by the American Diabetes Association for monitoring diabetes in 2379 primary care visits of patient with diabetes.

Results In the preceding 12 months, less than 60.0% of the patients were given a test recommended for monitoring diabetes (58.0% for HbA_1c and 57.0% for lipid profile). Continuity of care with PCPs increased the odds of adhering to diabetes monitoring guidelines by 36.0% for the HbA_1c test (P=0.06) and by 76.0% for the lipid profile test (P=0.0006).

Conclusion A substantial gap exists in achieving optimal monitoring for diabetes in primary care settings in the United States. While PCPs are ideally positioned to ensure that guidelines are closely followed, we found that even in primary care settings, patient-provider continuity of care was associated with guideline adherence.

Significance statement Adherence to clinical guidelines is an integral part of the World Health Organization’s Global Action Plan to reduce the impact of diabetes. In this study, we used the 2013 National Ambulatory Care Survey to assess US physicians’ adherence to the American Diabetes Association’s guidelines for monitoring diabetes. We found a substantial gap between what was done in primary care settings and what is recommended for optimal diabetes management. Our findings support the positive effect of continuity of care on improving diabetes quality of care.