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Medical Care for Patients with Diabetes: Epidemiologic Aspects

Maureen I. Harris, PhD MPH
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From the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland. For the current author address, see end of text. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “Risks and Benefits of Intensive Management in Non-Insulin-dependent Diabetes Mellitus: The Fifth Regenstrief Conference.” To view a complete list of the articles included in this supplement, please view its Table of Contents. Requests for Reprints: Maureen I. Harris, PhD, MPH, NIDDK/NIH, Natcher Building, Room 5AN24, 45 Center Drive, MSC 6600, Bethesda, MD 20892-6600.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(1_Part_2):117-122. doi:10.7326/0003-4819-124-1_Part_2-199601011-00007
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Objective: To describe the epidemiologic characteristics of physician care and self-care for adults with diabetes in the U.S. population.

Design and Subjects: Data are drawn from the 1989 National Health Interview Survey, in which a personal household interview was administered to a representative sample of U.S. adults aged 18 years or older. The response rate was 96% (n = 84 572). All subjects identified as having diabetes previously diagnosed by a physician were asked a series of questions about their diabetes. Response rate for this representative sample of U.S. diabetic patients was 95% (n = 2405).

Measurements: Self-reported information was obtained about various aspects of diabetes care, including care by physicians and self-care practices of the diabetic persons. Sociodemographic and clinical factors that may influence diabetes care were also determined.

Results: More than 90% of diabetic adults had one physician for the usual care of their diabetes, but 32% made fewer than four visits to this physician each year. Most physician visits by diabetic patients were not made to diabetes specialists, and the visit rate to other health care professionals such as ophthalmologists, podiatrists, and nutritionists was low. About half of insulin-treated diabetic subjects used multiple daily insulin injections; and 40% of patients with insulin-dependent diabetes mellitus, 26% of those with non–insulin-dependent diabetes mellitus (NIDDM) who were taking insulin, and 5% of those with NIDDM who were not taking insulin monitored their blood glucose level daily. Diabetes patient education classes had been attended by 35% of diabetic adults.

Conclusions: These and other data indicate that medical care for diabetic patients and their self-care practices may not be optimal for prevention of diabetes complications. The Diabetes Control and Complications Trial showed that achieving and maintaining near-normal glycemia, with a concomitant 50% to 70% reduction in diabetes complications, may require close monitoring and ongoing support from a health care team, ample financial resources, and advanced patient knowledge and motivation. Providing this level of diabetes management to all diabetic persons may require major changes in the health care system and in patient self-care practices.


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Figure 1.
Frequency of visits to a regular physician by adults with insulin-dependent (IDDM) and non–insulin-dependent diabetes mellitus (NIDDM) for diabetes care.

Sample sizes: patients with IDDM equals 124; patients with insulin-treated NIDDM equals 922; patients with NIDDM not treated with insulin equals 1346.

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Figure 2.
Proportion of adults with non–insulin-dependent diabetes mellitus (NIDDM) and without diabetes who were hospitalized in the past year (excluding hospitalizations for childbirth).

Sample sizes: patients with insulin-treated NIDDM equals 922; patients with NIDDM not treated by insulin equals 1346; nondiabetic patients equals 20 181.

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Figure 3.
Percentage of adults with non–insulin-dependent diabetes mellitus (NIDDM) who are treated with insulin and oral agents and who are following a diet for their diabetes, by years since diagnosis of diabetes.

Sample size: 2268 subjects with NIDDM.

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Figure 4.
Percentage of adults with diabetes who self-monitor their blood glucose level at least once per day.

Sample sizes: patients with insulin-dependent diabetes mellitus (IDDM) equals 124; patients with insulin-treated non–insulin-dependent diabetes mellitus (NIDDM) equals 922; patients with NIDDM not treated with insulin equals 1346. (Adapted from reference 12.).

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Figure 5.
The mean fasting plasma glucose level in subjects without diabetes and in representative patient populations in U.

S. community-based studies. DM equals diabetes; Japn Amer equals Japanese American; Hisp equals Hispanic; Native Amer equals Native American. Adapted from reference 29.

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