title: Does low socioeconomic status affect use of nutritional services by pre-diabetes patients?
abstract: OBJECTIVE
  This paper's aim is to identify whether community-level socioeconomic status (SES) predicts: screening test for pre-diabetes; actual diagnosis of pre-diabetes; or nutritional counseling.
  
  
  METHODS
  This is an analysis of 1,348,124 insured adults receiving medical care from Maccabi Healthcare Services (MHS) in 107 MHS clinics throughout Israel. The research population comprised 79 percent of the MHS members over 18 years of age in 2004-2006. Area level socioeconomic data were drawn from the Israel Central Bureau of Statistics SES index for every geographical area and each MHS clinic in the study was coded from: - 1.03 to 2.73 (- 1.03 indicating low SES and 2.73 + high SES) according to the SES index for the location. The fasting glucose laboratory test was used for analysis. Pre-diabetes diagnosis was based on a fasting glucose above 100 mg/dl. Nutritional counseling was defined by dietitian visits in the claims database.
  
  
  RESULTS
  The percentage of insured individuals who underwent blood glucose testing during the study increased with age from 67 percent at ages 18-45 to92 percent for age 65 and over. The percentage of individuals diagnosed with pre-diabetes also increased with age, rising from 4 percent in the younger group to 14 percent in those aged 46-65 and to 14-16 percent of 65 and older. The percentage of individuals with pre-diabetes who visited a dietitian was 16-27 percent for those under 65 and 14-17 percent for those over 65 (males and females, respectively). Individuals living in lower socioeconomic areas were less likely to have blood tests. Among tested patients, the prevalence of pre-diabetes was higher in areas of lower SES and their dietitian visits were less frequent.
  
  
  CONCLUSIONS
  In lower SES index areas, there is a need for better identification and treatment of patients.
  
  
  CONCLUSIONS
  The paper shows that a proactive approach is needed both to detect pre-diabetes and to encourage patients to receive nutritional treatment.
authors.affiliation: Maccabi Healthcare Services, Tel Aviv, Israel. rendevelt@univ.hafia.ac.il
authors.forename: Ronit
authors.initials: R
authors.lastname: Endevelt
authors.forename: Orna
authors.initials: O
authors.lastname: Baron-Epel
authors.forename: Tomas
authors.initials: T
authors.lastname: Karpati
authors.forename: Anthony David
authors.initials: AD
authors.lastname: Heymann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000178:diet therapy* / Q000453:epidemiology*; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose