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Diabetes Prevention Falls Short, Far Short

States are far from meeting 2010 goals. Americans with diabetes aren’t receiving preventive treatments as often or as thoroughly as they should, a new study says. Despite a variety of outreach efforts, preventive care for adults with non-insulin dependent diabetes (Type II) differs vastly depending on factors like age, race and income, according to the government scientists who prepared the report.

The findings, which are intended to be a benchmark for education efforts in the coming decade, shows that it’s clear there’s plenty of room for improvement says the Centers for Disease Control and Prevention in Atlanta.

"Some people feel that you can’t do anything about diabetes. Our take on that is that [patients] can do something about it to either delay or prevent the onset of complications. You can be in control, you can improve your outcome, but it’s going to take work."

More than 15 million Americans have diabetes. Most have the adult-onset, or Type II, form of the condition, in which their cells lose their sensitivity to the hormone insulin, which helps the body extract sugar from blood.

The number of Americans with diabetes rose 33 percent between 1990 and 1998, the CDC says, thanks largely to a jump in how fat people are becoming.

Although diabetes can be easily controlled — with drugs, regular injections of insulin, changes in diet and exercise — if unchecked it can cause serious health problems and even death.

Diabetes is the leading cause of adult blindness and a major source of kidney, heart and vessel disease, health officials say. Nerve damage from the condition leads to more than 56,000 amputations a year, more then half of which could be prevented, experts say.

The study, based on a phone survey between 1997 and 1999, focused on several key measures of preventive treatment for diabetics: blood sugar self-testing, eye exams to watch for signs of blindness linked to the disease, and foot exams to catch nerve and tissue damage that can lead to amputation. They also looked at rates of another blood test, for a protein called HbA1C, which marks the progress of the disease.

For all gauges, the average percentages of diabetics who reported receiving these tests were far below the health goals set for the year 2010, which themselves stop below 80 percent of all patients.

Sugar monitoring rates ranged from about 30 percent of people surveyed in Hawaii, to 65.5 percent in Montana — the only state to meet the 2010 goal of 60 percent. The percentage of people receiving yearly eye exams ranged from 47 percent in Arkansas to 81 percent in Massachusetts, one of just three states to meet the 2010 guideline of 75 percent for this test.

No state met the 2010 yardsticks for either annual foot exams or the HbA1C screening.

The use of preventive care ranged widely from state to state, but was generally low in the south and higher in the northeast, the researchers say. Age was a factor, too. People over 45 were more likely to have an annual eye exam, while those over 75 were less likely to check their own blood sugar, the study found.

"It’s really not clear from our data why some states are lower that others," Tierney says. Possible factors include differences in demographics, attitudes among patients, variations in the way doctors practice medicine, and social and economic forces, he says. Not surprisingly, patients without health insurance were less likely to report getting preventive care for their diabetes.

What To Do

Outreach efforts to patients and physicians should help improve access to preventive care, as should the increasing numbers of health insurers that are incorporating diabetes management into their treatment guidelines.