Targets and reality: a comparison of health care indicators in the U.S. (Pittsburgh Epidemiology of Diabetes Complications Study) and Hungary (DiabCare Hungary).
OBJECTIVE
In the U.S., both primary care and specialist physicians share in the care of type 1 diabetic patients, often in an informal collaboration. In Hungary, however, type 1 diabetic patients are generally managed in special centralized diabetes units. These different treatment settings may lead to different health care practices and outcomes. To determine if this is true, diabetes care indicators and complications were compared across representative study populations from the 2 countries.


METHODS
The Pittsburgh Epidemiology of Diabetes Complications Study (EDC) is a prospective cohort of childhood-onset type 1 diabetic patients. DiabCare Hungary, a multicenter cross-sectional study, was developed for quality control purposes and provides a nationwide data set of diabetic patients. We identified 2 comparable populations (EDC, n = 416; DiabCare, n = 405) in terms of age (> or =14 years) and age at onset (<17 years).


RESULTS
EDC patients were less likely to receive diabetes education (P<0.0001), see an ophthalmologist (P<0.0001), be treated by diabetologists (P<0.0001), or perform self-monitoring of blood glucose (P<0.0001). They were more likely to use conservative insulin regimens (i.e., 1-2 injections/day, P<0.0001) and have a higher glycated hemoglobin (P< 0.0001). DiabCare patients more often experienced severe hypoglycemia (P<0.01) and had a lower prevalence of proliferative retinopathy (P<0.0001), legal blindness (P<0.05), and albuminuria (> or =30 mg/day P<0.01). No significant differences in macrovascular complications were seen, although rates were generally low


CONCLUSIONS
These data suggest that the 2 populations differ by their diabetes care practices, degree of glycemic control, and microvascular complication status.
Tabák
A G
AG
National Centre for Diabetes Care, Semmelweis University of Medicine, Budapest, Hungary.
Tamás
G
G
Zgibor
J
J
Wilson
R
R
Becker
D
D
Kerényi
Z
Z
Orchard
T J
TJ
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000453:epidemiology; D005194:Family Practice; D005260:Female; D006304:Health Status; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D008297:Male; D008511:Medicine; D009203:Myocardial Infarction / Q000453:epidemiology; D010353:Patient Education as Topic; D019984:Quality Indicators, Health Care; D013038:Specialization; D014481:United States / Q000453:epidemiology