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Diabetes Care Has Improved in US, but Still Not Perfect

Diabetes care has improved in the US over the last decade, but there is still plenty of room for improvement in control of cholesterol levels, blood pressure, and glycemia. The findings are based on an analysis of data from the National Health and Nutrition Examination Survey (1988 to 1994, and 1995 to 2002) and the Behavioral Risk Factor Surveillance System (1995 and 2002). The study focused on adults with a diagnosis of diabetes.

During the study period, the rate of poor glycemic control fell by 3.9% (p = NS), while the rate of fair or good lipid control rose by 21.9% (p < 0.05), lead author Dr. Jinan B. Saaddine, from the Centers for Disease Control and Prevention in Atlanta, and colleagues note. The average LDL cholesterol level dropped by 18.8 mg/dL.

No significant change in mean HbA1c was seen, but the proportion of patients with levels between 6% to 8% increased from 34.2% to 47.0%, the authors note. No change in blood pressure distribution occurred.

Screening for diabetes-related complications, based on rates of annual lipid testing, dilated eye examination, and foot examination, rose by as much as 8.3% during the study period. In addition, rates of annual influenza vaccination and aspirin use climbed by 6.8% and 13.1%, respectively.

Now for the bad news. Currently, two in five diabetics have poor LDL cholesterol control, one in three have poor blood pressure control, and one in five have poor glycemic control.

"Ensuring access to and delivering high-quality care for all people with diabetes should be a national priority," the researchers emphasize. "Understanding how to better implement known and existing diabetes care interventions within finite resources may be the key."
Ann Intern Med 2006;144:465-474.

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