Population-Based Assessment of the Level of Care Among Adults With Diabetes in the U.S

  1. David F Williamson, PHD
  1. Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention Atlanta, Georgia
  2. The Prudential Center for Health Care Research Atlanta, Georgia
  3. Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Michigan Ann Arbor, Michigan
  1. 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: glb4{at}cdc.gov.

Abstract

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.
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