The
Diabetes Report Card for the United States
Improving
diabetes care in the United States is a topic of concern.
The
objective was to document the quality of diabetes care during
1988-1995. The study
used National population-based cross-sectional surveys.
SETTING:
Third U.S. National Health and Nutrition Examination Survey
(NHANES III)
(1988-1994)
and the Behavioral Risk Factors Surveillance System (BRFSS)
(1995).
PARTICIPANTS:
Participants in NHANES III (n = 1026) or BRFSS (n = 3059) who were
18 to 75 years of age and reported a physician diagnosis of
diabetes. Women with gestational diabetes were excluded.
MEASUREMENTS:
Glycemic control, blood pressure, low-density lipoprotein (LDL)
cholesterol level, biannual cholesterol monitoring, and annual
foot and dilated eye examination, as defined by the Diabetes
Quality Improvement Project.
RESULTS:
18.0% of participants (95% CI, 15.7% to 22.3%) had poor glycemic
control (hemoglobin A(1c) level > 9.5%).
65.7%
(CI, 62.0% to 69.4%) had blood pressure less than 140/90 mm Hg.
Cholesterol
was monitored biannually in 85.3% (CI, 83.1% to 88.6%) of
participants, but only 42.0% (CI, 34.9% to 49.1%) had LDL
cholesterol levels less than 3.4 mmol/L (<130 mg/dL).
During
the previous year, 63.3% (CI, 59.6% to 67.0%) had a dilated eye
examination.
54.8%
(CI, 51.3% to 58.3%) had a foot examination.
When
researchers controlled for age, sex, ethnicity, education, health
insurance, insulin use, and duration of diabetes, insured persons
were more likely than uninsured persons to have a dilated eye
examination (66.5% [CI, 62.6% to 70.4%]) vs. 43.2% [CI, 29.5% to
56.9%]) and were less likely to have a hemoglobin A(1c)level
greater than or equal to 9.5%.
Persons
taking insulin were more likely than those who were not to have
annual dilated eye examination (72.2% [CI, 66.3% to 78.1%] vs.
57.6% [CI, 53.7% to 61.5%]) and foot examination (67.3% [CI, 61.4%
to 73.2%] vs. 47.1% [CI, 43.2% to 51.0%]) but were also more
likely to have poor glycemic control (24.2% [CI, 18.3% to 30.1%]
vs. 15.5% [CI, 11.6% to 19.4%]).
CONCLUSIONS:
According to U.S. data collected during 1988-1995, a gap exists
between recommended diabetes care and the care patients actually
receive. These data offer a benchmark for monitoring changes in
diabetes care.
Ann Intern Med 2002 Apr 16;136(8):565-74
Division
of Diabetes Translation, National Center for Chronic Disease
Prevention and Health Promotion, Centers for Disease Control and
Prevention, Atlanta, Georgia 30341, USA. zna2@cdc.gov
