Diabetes management in the USA and England: comparative analysis of national surveys.
OBJECTIVE
To compare diabetes management in adults between England and the United States, particularly focusing on the impact of a universal access health insurance system.


METHODS
Analysis of the nationally-representative surveys Health Survey of England, 2003 (unweighted n =14 057) and the National Health and Nutrition Examination Survey, 2001-2002 (unweighted n =5411).


METHODS
Adults 20-64 years of age; individuals >65.


METHODS
Glycaemic, lipid and blood pressure control and medication use among individuals with previously diagnosed diabetes.


RESULTS
Among those aged 20-64 the prevalence of diagnosed diabetes was lower in England (2.7%) than in the USA (5.0%). The proportion with diabetes receiving treatment was similar for the two countries. However, the mean HbA1c in England was 7.6%: in the USA it was 7.5% for those with insurance and 8.6% for those without insurance. The proportion of individuals on ACE inhibitors in England was 39%: in USA it was 39% for those with insurance, and 14% for those without.


CONCLUSIONS
Individuals in a healthcare system providing universal access have better managed diabetes than those in a market based system once one accounts for insurance.
Mainous
Arch G
AG
Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA. mainouag@musc.edu
Diaz
Vanessa A
VA
Saxena
Sonia
S
Baker
Richard
R
Everett
Charles J
CJ
Koopman
Richelle J
RJ
Majeed
Azeem
A
D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use*; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006306:Health Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use*; D007328:Insulin / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
D000806:Angiotensin-Converting Enzyme Inhibitors; D007004:Hypoglycemic Agents; D007328:Insulin