A Diabetes Report Card for the United States, 1988–1995

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The summary below is from the full report titled "A Diabetes Report Card for the United States: Quality of Care in the 1990s." It is in the 16 April 2002 issue of Annals of Internal Medicine (volume 136, pages 565-574). The authors are JB Saaddine, MM Engelgau, GL Beckles, EW Gregg, TJ Thompson, and KMV Narayan.

What is the problem and what is known about it so far?

Diabetes mellitus is a common disease that interferes with the body's ability to store energy from food. The pancreas makes a substance called insulin that helps to store energy from food. Type 1 diabetes mellitus (also called juvenile diabetes) occurs when the pancreas stops making insulin. In type 2 diabetes mellitus (also called adult-onset diabetes), the body makes plenty of insulin but is unable to use it normally. In both cases, the result is high blood sugar levels. Over time, high blood sugar levels can lead to blindness, kidney failure, nerve damage, and heart disease. Fortunately, good care with diet, exercise, and medications to keep blood sugar under control can prevent the development of these serious, costly complications. The control of blood pressure and cholesterol is also very important for patients with diabetes. Because it is possible to accomplish so much with good care, it is important to know about the general quality of diabetes care in the United States. To date, no one has provided a "national report card" to show how well the United States is achieving the promise of medical care for diabetes.

Why did the researchers do this particular study?

To estimate the general quality of diabetes care in the United States.

Who was studied?

The researchers used information from two studies. In one, 1026 adults with diabetes answered a large national survey about health and nutrition. In the other, 3059 patients with diabetes participated in a study of behavior-related risk factors.

How was the study done?

The researchers used this information to estimate the numbers of diabetic Americans who had adequate control of blood sugar, blood pressure, and cholesterol and who had recommended yearly eye and foot examinations.

What did the researchers find?

Many patients had inadequate control of blood sugar (18%), blood pressure (34%), and cholesterol (58%), and many patients did not have the recommended yearly eye (37%) or foot (45%) examinations. People without health insurance were less likely than those with health insurance to have eye and foot examinations and to have adequate blood sugar control.

What were the limitations of the study?

The study used information from 1988–1995 and may not accurately reflect the quality of diabetes care in more recent years.

What are the implications of the study?

There is much room for improvement in the general care of Americans with diabetes. In addition, lack of health insurance puts diabetic patients at increased risk for poor care. Efforts to improve diabetes care can be measured against this study to judge successes. In addition, it will be valuable to check the general quality of diabetes care in the United States every few years with a national report card like the one used in this study.