Population-based assessment of the level of care among adults with diabetes in the US

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. RESEARCH DESIGN AND METHODS - A cross-sectional study was conducted using a sample of 2,118 adults, age greater than or equal to 18 years, with self-reported diabetes in 22 states that participated in the 1994 Behavioral Risk Factor Surveillance System. Most subjects were age greater than or equal to 45 years (83%), women (51%), and white (75%) and were diagnosed at ages greater than or equal to 30 years (83%), had type 2 diabetes (89%), and mere 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" (HbA(1c)). 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 HbA(1c) 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.