title: Population-based assessment of the level of care among adults with diabetes in the U.S.
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.
  
  
  METHODS
  A cross-sectional study was conducted using a sample of 2,118 adults, age > or =18 years, with self-reported diabetes in 22 states that participated in the 1994 Behavioral Risk Factor Surveillance System. Most subjects were age > or =45 years (83%), women (51%), and white (75%) and were diagnosed at ages > or =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.
authors.affiliation: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. glb4@cdc.gov
authors.forename: G L
authors.initials: GL
authors.lastname: Beckles
authors.forename: M M
authors.initials: MM
authors.lastname: Engelgau
authors.forename: K M
authors.initials: KM
authors.lastname: Narayan
authors.forename: W H
authors.initials: WH
authors.lastname: Herman
authors.forename: R E
authors.initials: RE
authors.lastname: Aubert
authors.forename: D F
authors.initials: DF
authors.lastname: Williamson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance; D011314:Preventive Health Services; D012307:Risk Factors; D012648:Self Care; D014481:United States; D044465:White People / Q000706:statistics & numerical data
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin