Population-based assessment of the level of care among adults with diabetes in the U.S.
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.
Beckles
G L
GL
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
Engelgau
M M
MM
Narayan
K M
KM
Herman
W H
WH
Aubert
R E
RE
Williamson
D F
DF
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
D001786:Blood Glucose; D006442:Glycated Hemoglobin