Issue 133 Item 2 Care for US Patients with Diabetics Varies Among States

According to a new study, the level of care that diabetes patients receive in the United States varies widely from state to state, often falling far below current national recommendations. The new findings are based on a national survey including nearly 2 million Medicare patients between the ages of 18 and 75 who were diagnosed with diabetes.

Overall, one third of patients did not have annual hemoglobin A1c tests, which measure long-term blood sugar control, according to the report published in the December issue of the journal Diabetes Care. And more than one third did not have eye exams and tests of blood fat levels every 2 years, as recommended.

People with diabetes face a high risk of blindness, which is why they are urged to have regular eye exams.

In general, lead author Dr. David R. Arday of Army Medical Surveillance Activity in Washington, DC, and colleagues found that there was a great deal of variation both among states and within states when they assessed how often patients got one of the three tests recommended for diabetes patients.

More people tended to get hemoglobin A1c tests and eye exams in New England, the upper Midwest and the Pacific Northwest, while fewer got them in the Ohio valley, lower Mississippi valley and the Southwest. Blood fat or lipid tests, on the other hand, were given more often in the mid-Atlantic states and some Southern coastal states, but less often in the Rocky Mountain states and parts of the lower Mississippi valley, the authors report.

"Variation among states in the care for diabetes is not unexpected, since similar variation has been documented previously," Arday and colleagues write.

"However, to our knowledge, this is the first study with this large a number of people (almost 2 million) to examine the impact of characteristics of individuals residing within states on the variability of care provided among states," the authors add.

The investigators call for more research on the causes of variability in care for US diabetes patients with the hope of improving the overall quality of diabetes care. Diabetes Care 2002;25:2230-2237