Population-Based Assessment of the Level of Care Among Adults With Diabetes in the U.S
- Gloria LA Beckles, MBBS, MSC,
- Michael M Engelgau, MD, MS,
- KM Venkat Narayan, MD, MSC, MBA,
- William H Herman, MD, MPH,
- Ronald E Aubert, PHD and
- David F Williamson, PHD
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention Atlanta, Georgia
- The Prudential Center for Health Care Research Atlanta, Georgia
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Michigan Ann Arbor, Michigan
- Address correspondence and reprint requests to Gloria L.A. Beckles, MBBS, MSc, Division of Diabetes Translation, Mailstop K-10, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341. E-mail: .
OBJECTIVE To estimate the levels of use of preventive care and to identify correlates of such care among people with diabetes in the U.S.
RESEARCH DESIGN AND METHODS A cross-sectional study was conducted using a sample of 2,118 adults, age ≥18 years, with self-reported diabetes in 22 states that participated in the 1994 Behavioral Risk Factor Surveillance System. Most subjects were age ≥45 years (83%), women (51%), and white (75%) and were diagnosed at ages ≥30 years (83%), had type 2 diabetes (89%), and were not using insulin (66%).
RESULTS Among all people with diabetes, 78% practiced self-monitoring of blood glucose, and 25% were aware of the term “glycosylated hemoglobin” or “hemoglobin A one C” (HbA1c). In the last year, 72% of the subjects visited a health care provider for diabetes care at least once, 61% had their feet inspected at least once, and 61% received a dilated eye examination. Controlled for age and sex, the odds ratios (ORs) for insulin use were for self-monitoring (OR [95% CI]; 4.0 [2.6–6.1]); having heard of HbA1c or receipt of a dilated eye examination (1.9 [1.4–2.5]); at least one visit to a provider (3.4 [1.9–7.2]); and feet inspected at least once (2.1 [1.5–2.9]). In addition, people <45 years, those who did not complete high school, and those without insurance coverage were high-risk groups for underuse of preventive care. Only 3% of insulin users and 1% of nonusers met all five of the American Diabetes Association standards in the previous year.
CONCLUSIONS Underuse of recommended preventive care practices is common among people with diabetes.
- Received January 27, 1998.
- Revision received May 27, 1998.
- Accepted May 27, 1998.
- Copyright © 1998 by the American Diabetes Association