Jinan B. Saaddine, MD; Michael M. Engelgau, MD; Gloria L. Beckles, MD; Edward W. Gregg, PhD; Theodore J. Thompson, MS; K.M. Venkat Narayan, MD
Requests for Single Reprints: Jinan B. Saaddine, MD, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE (MS-K10), Atlanta, GA 30341; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Saaddine, Engelgau, Beckles, Gregg, and Narayan and Mr. Thompson: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE (MS-K10), Atlanta, GA 30341.
Author Contributions: Conception and design: J.B. Saaddine, M.M. Engelgau, K.M.V. Narayan.
Analysis and interpretation of the data: J.B. Saaddine, M.M. Engelgau, K.M.V. Narayan.
Drafting of the article: J.B. Saaddine, M.M. Engelgau, E.W. Gregg, K.M.V. Narayan.
Critical revision of the article for important intellectual content: J.B. Saaddine, M.M. Engelgau, G.L. Beckles, E.W. Gregg, T.J. Thompson, K.M.V. Narayan.
Final approval of the article: J.B. Saaddine, M.M. Engelgau, G.L. Beckles, E.W. Gregg, T.J. Thompson, K.M.V. Narayan.
Provision of study materials or patients: J.B. Saaddine.
Statistical expertise: T.J. Thompson.
Administrative, technical, or logistic support: J.B. Saaddine, M.M. Engelgau, G.L. Beckles, K.M.V. Narayan.
Improving diabetes care in the United States is a topic of concern.
To document the quality of diabetes care during 1988–1995.
National population-based cross-sectional surveys.
Third U.S. National Health and Nutrition Examination Survey (NHANES III) (1988–1994) and the Behavioral Risk Factors Surveillance System (BRFSS) (1995).
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.
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.
18.0% of participants (95% CI, 15.7% to 22.3%) had poor glycemic control (hemoglobin A1c level > 9.5%), and 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 and 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 A1clevel 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%]).
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.
There are no recent national evaluations of diabetes care in the United States.
Using data from two national surveys, this study documents a substantial gap between the recommended and actual care of diabetes in the United States between 1988 and 1995. Many participants had hemoglobin A1c levels greater than 9.5% (18.0%), poorly controlled blood pressure (34.3%), and elevated cholesterol levels (58.0%).
As a nation, the United States is falling short in caring for patients with diabetes. A periodic national “report card” may help us to gauge the success of future efforts to improve.
Table 1. Characteristics of Persons with Self-Reported Diabetes in the Third U.S. National Health and Nutrition Examination Survey (1988–1994) and the Behavioral Risk Factors Surveillance System1995
Table 2. Diabetes Quality Improvement Project Indicators and Related Data Sources
Table 3. Persons 18 to 75 Years of Age with Diabetes in the Third U.S. National Health and Nutrition Examination Survey and the Behavioral Risk Factors Surveillance System Who Were Receiving Preventive Care
Distribution of quality improvement measures in persons with diabetes.
Table 4. Predictive Marginal Prevalence of Accountability Measures for Persons in the Third U.S. National Health and Nutrition Examination Survey and the Behavioral Risk Factors Surveillance System, according to Demographic and Clinical Variables
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Saaddine JB, Engelgau MM, Beckles GL, Gregg EW, Thompson TJ, Narayan KV. A Diabetes Report Card for the United States: Quality of Care in the 1990s. Ann Intern Med. ;136:565–574. doi: 10.7326/0003-4819-136-8-200204160-00005
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Published: Ann Intern Med. 2002;136(8):565-574.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Healthcare Delivery and Policy.
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