Article    Table of Contents                    Full Text of this article Free    PDF of this article (PDFs free after 6 months)    Summary for Patients    Summary for Patients (PDF)    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Saaddine, J. B.    Narayan, K.M. V.    Related Articles in PubMed    PubMed Citation    PubMed

ARTICLE

A Diabetes Report Card for the United States: Quality of Care in the 1990s

Jinan B. Saaddine, MD; Michael M. Engelgau, MD; Gloria L. Beckles, MD; Edward W. Gregg, PhD; Theodore J. Thompson, MS; and K.M. Venkat Narayan, MD

16 April 2002 | Volume 136 Issue 8 | Pages 565-574

Background: Improving diabetes care in the United States is a topic of concern.

Objective: To document the quality of diabetes care during 1988–1995.

Design: National population-based cross-sectional surveys.

Setting: Third U.S. National Health and Nutrition Examination Survey (NHANES III) (1988–1994) and the Behavioral Risk Factors Surveillance System (BRFSS) (1995).

Participants: Participants in NHANES III (n = 1026) or BRFSS (n = 3059) who were 18 to 75 years of age and reported a physician diagnosis of diabetes. Women with gestational diabetes were excluded.

Measurements: Glycemic control, blood pressure, low-density lipoprotein (LDL) cholesterol level, biannual cholesterol monitoring, and annual foot and dilated eye examination, as defined by the Diabetes Quality Improvement Project.

Results: 18.0% of participants (95% CI, 15.7% to 22.3%) had poor glycemic control (hemoglobin A_1c level > 9.5%), and 65.7% (CI, 62.0% to 69.4%) had blood pressure less than 140/90 mm Hg. Cholesterol was monitored biannually in 85.3% (CI, 83.1% to 88.6%) of participants, but only 42.0% (CI, 34.9% to 49.1%) had LDL cholesterol levels less than 3.4 mmol/L (<130 mg/dL). During the previous year, 63.3% (CI, 59.6% to 67.0%) had a dilated eye examination and 54.8% (CI, 51.3% to 58.3%) had a foot examination. When researchers controlled for age, sex, ethnicity, education, health insurance, insulin use, and duration of diabetes, insured persons were more likely than uninsured persons to have a dilated eye examination (66.5% [CI, 62.6% to 70.4%]) vs. 43.2% [CI, 29.5% to 56.9%]) and were less likely to have a hemoglobin A_1clevel greater than or equal to 9.5%. Persons taking insulin were more likely than those who were not to have annual dilated eye examination (72.2% [CI, 66.3% to 78.1%] vs. 57.6% [CI, 53.7% to 61.5%]) and foot examination (67.3% [CI, 61.4% to 73.2%] vs. 47.1% [CI, 43.2% to 51.0%]) but were also more likely to have poor glycemic control (24.2% [CI, 18.3% to 30.1%] vs. 15.5% [CI, 11.6% to 19.4%]).

Conclusions: According to U.S. data collected during 1988–1995, a gap exists between recommended diabetes care and the care patients actually receive. These data offer a benchmark for monitoring changes in diabetes care.

Editors' Notes Context There are no recent national evaluations of diabetes care in the United States. Contribution Using data from two national surveys, this study documents a substantial gap between the recommended and actual care of diabetes in the United States between 1988 and 1995. Many participants had hemoglobin A1c levels greater than 9.5% (18.0%), poorly controlled blood pressure (34.3%), and elevated cholesterol levels (58.0%). Implications As a nation, the United States is falling short in caring for patients with diabetes. A periodic national "report card" may help us to gauge the success of future efforts to improve. –The Editors

 

Author and Article Information

From the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

Requests for Single Reprints: Jinan B. Saaddine, MD, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE (MS-K10), Atlanta, GA 30341; e-mail, zna2{at}cdc.gov.

Current Author Addresses: Drs. Saaddine, Engelgau, Beckles, Gregg, and Narayan and Mr. Thompson: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE (MS-K10), Atlanta, GA 30341.

Author Contributions: Conception and design: J.B. Saaddine, M.M. Engelgau, K.M.V. Narayan.

Analysis and interpretation of the data: J.B. Saaddine, M.M. Engelgau, K.M.V. Narayan.

Drafting of the article: J.B. Saaddine, M.M. Engelgau, E.W. Gregg, K.M.V. Narayan.

Critical revision of the article for important intellectual content: J.B. Saaddine, M.M. Engelgau, G.L. Beckles, E.W. Gregg, T.J. Thompson, K.M.V. Narayan.

Final approval of the article: J.B. Saaddine, M.M. Engelgau, G.L. Beckles, E.W. Gregg, T.J. Thompson, K.M.V. Narayan.

Provision of study materials or patients: J.B. Saaddine.

Statistical expertise: T.J. Thompson.

Administrative, technical, or logistic support: J.B. Saaddine, M.M. Engelgau, G.L. Beckles, K.M.V. Narayan.

Related articles in Annals:

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

Annals 2002 136: I24. [Full Text]  

Letters
Managing People at High Risk for Diabetes
William H. Herman, Thomas J. Hoerger, Katherine Hicks, Michael Brandle, Stephen W. Sorensen, Ping Zhang, Michael M. Engelgau, Richard F. Hamman, David G. Marrero, Ronald T. Ackermann, AND Robert E. Ratner

Annals 2006 144: 66-67. [Full Text]  

This article has been cited by other articles:

				M. Heisler, M. M. Hogan, T. P. Hofer, J. A. Schmittdiel, M. Pladevall, and E. A. Kerr When More Is Not Better: Treatment Intensification Among Hypertensive Patients With Poor Medication Adherence Circulation, June 3, 2008; 117(22): 2884 - 2892. [Abstract] [Full Text] [PDF]

				R. E. Goldman, M. Sanchez-Hernandez, D. Ross-Degnan, J. D. Piette, C. M. Trinacty, and S. R. Simon Developing an automated speech-recognition telephone diabetes intervention Int. J. Qual. Health Care, May 20, 2008; (2008) mzn021v1. [Abstract] [Full Text] [PDF]

				Diabetes Educators: Implementing the Chronic Care Model The Diabetes Educator, May 1, 2008; 34(3): 451 - 456. [Full Text] [PDF]

				P. W. Tuerk, M. Mueller, and L. E. Egede Estimating Physician Effects on Glycemic Control in the Treatment of Diabetes: Methods, effects sizes, and implications for treatment policy Diabetes Care, May 1, 2008; 31(5): 869 - 873. [Abstract] [Full Text] [PDF]

				U. Rothe, G. Muller, P. E.H. Schwarz, M. Seifert, H. Kunath, R. Koch, S. Bergmann, U. Julius, S. R. Bornstein, M. Hanefeld, et al. Evaluation of a Diabetes Management System Based on Practice Guidelines, Integrated Care, and Continuous Quality Management in a Federal State of Germany: A population-based approach to health care research Diabetes Care, May 1, 2008; 31(5): 863 - 868. [Abstract] [Full Text] [PDF]

				W. J. Borges and S. K. Ostwald Improving Foot Self-Care Behaviors With Pies Sanos West J Nurs Res, April 1, 2008; 30(3): 325 - 341. [Abstract] [PDF]

				M. Heisler Actively Engaging Patients in Treatment Decision Making and Monitoring as a Strategy to Improve Hypertension Outcomes in Diabetes Mellitus Circulation, March 18, 2008; 117(11): 1355 - 1357. [Full Text] [PDF]

				A. D. Naik, M. A. Kallen, A. Walder, and R. L. Street Jr Improving Hypertension Control in Diabetes Mellitus: The Effects of Collaborative and Proactive Health Communication Circulation, March 18, 2008; 117(11): 1361 - 1368. [Abstract] [Full Text] [PDF]

				T. R. Frieden and F. Mostashari Health Care as If Health Mattered JAMA, February 27, 2008; 299(8): 950 - 952. [Full Text] [PDF]

				A. Turchin, M. Shubina, A. H. Chodos, J. S. Einbinder, and M. L. Pendergrass Effect of Board Certification on Antihypertensive Treatment Intensification in Patients With Diabetes Mellitus Circulation, February 5, 2008; 117(5): 623 - 628. [Abstract] [Full Text] [PDF]

				Diabetes Education and Public Health The Diabetes Educator, January 1, 2008; 34(1): 45 - 48. [Full Text] [PDF]

				Club Diabete Sicili@ Five-Year Impact of a Continuous Quality Improvement Effort Implemented by a Network of Diabetes Outpatient Clinics Diabetes Care, January 1, 2008; 31(1): 57 - 62. [Abstract] [Full Text] [PDF]

				J. S. Tabrizi, A. J. Wilson, P. K. O'Rourke, and E. T. Coyne Patient Perspectives on Consistency of Medical Care With Recommended Care in Type 2 Diabetes Diabetes Care, November 1, 2007; 30(11): 2855 - 2856. [Full Text] [PDF]

				M. L. Parchman, J. A. Pugh, C.-P. Wang, and R. L. Romero Glucose Control, Self-Care Behaviors, and the Presence of the Chronic Care Model in Primary Care Clinics Diabetes Care, November 1, 2007; 30(11): 2849 - 2854. [Abstract] [Full Text] [PDF]

				S. Kirsh, S. Watts, K. Pascuzzi, M. E. O'Day, D. Davidson, G. Strauss, E. O Kern, and D. C Aron Shared medical appointments based on the chronic care model: a quality improvement project to address the challenges of patients with diabetes with high cardiovascular risk Qual. Saf. Health Care, October 1, 2007; 16(5): 349 - 353. [Abstract] [Full Text] [PDF]

				M. Heisler, J. D. Faul, R. A. Hayward, K. M. Langa, C. Blaum, and D. Weir Mechanisms for Racial and Ethnic Disparities in Glycemic Control in Middle-aged and Older Americans in the Health and Retirement Study Arch Intern Med, September 24, 2007; 167(17): 1853 - 1860. [Abstract] [Full Text] [PDF]

				C. R Taylor, J. T Hepworth, P. I Buerhaus, R. Dittus, and T. Speroff Effect of crew resource management on diabetes care and patient outcomes in an inner-city primary care clinic Qual. Saf. Health Care, August 1, 2007; 16(4): 244 - 247. [Abstract] [Full Text] [PDF]

				A. L. Fairchild and A. Alkon Back to the Future? Diabetes, HIV, and the Boundaries of Public Health Journal of Health Politics Policy and Law, August 1, 2007; 32(4): 561 - 593. [Abstract] [PDF]

				R. W. Grant, D. J. Wexler, A. J. Watson, W. T. Lester, E. Cagliero, E. G. Campbell, and D. M. Nathan How Doctors Choose Medications to Treat Type 2 Diabetes: A national survey of specialists and academic generalists Diabetes Care, June 1, 2007; 30(6): 1448 - 1453. [Abstract] [Full Text] [PDF]

				A. Turchin, M. Shubina, and M. L. Pendergrass Relationship of Physician Volume With Process Measures and Outcomes in Diabetes Diabetes Care, June 1, 2007; 30(6): 1442 - 1447. [Abstract] [Full Text] [PDF]

				S. Korsatko, W. Habacher, I. Rakovac, J. Plank, S. Seereiner, P. Beck, R. Gfrerer, P. Mrak, B. Bauer, M. Grossschadl, et al. Evaluation of a Teaching and Treatment Program in Over 4,000 Type 2 Diabetic Patients After Introduction of Reimbursement Policy for Physicians Diabetes Care, June 1, 2007; 30(6): 1584 - 1586. [Full Text] [PDF]

				R. Dorsey, T. Songer, J. Zgibor, S. Kelsey, S. Ibrahim, and T. Orchard Does Patient Behavior or Access Factors Have the Largest Influence on Screening in Type 1 Diabetes? Diabetes Care, April 1, 2007; 30(4): 867 - 871. [Abstract] [Full Text] [PDF]

				A. P.S. Kong, X. Yang, G. T.C. Ko, W.-Y. So, W.-B. Chan, R. C.W. Ma, V. W.S. Ng, C.-C. Chow, C. S. Cockram, P. C.Y. Tong, et al. Effects of Treatment Targets on Subsequent Cardiovascular Events in Chinese Patients With Type 2 Diabetes Diabetes Care, April 1, 2007; 30(4): 953 - 959. [Abstract] [Full Text] [PDF]

				S. Dowell, T. W. Oates, and M. Robinson Implant success in people with type 2 diabetes mellitus with varying glycemic control: A pilot study J Am Dent Assoc, March 1, 2007; 138(3): 355 - 361. [Abstract] [Full Text] [PDF]

				R. W. Grant and J. B. Meigs Prevalence and Treatment of Low HDL Cholesterol Among Primary Care Patients With Type 2 Diabetes: An unmet challenge for cardiovascular risk reduction Diabetes Care, March 1, 2007; 30(3): 479 - 484. [Abstract] [Full Text] [PDF]

				H. M. Choe, K. A. Townsend, G. Blount, C. H. Lo, L. Sadowski, and C. J. Standiford Treatment and control of blood pressure in patients with diabetes mellitus Am. J. Health Syst. Pharm., January 1, 2007; 64(1): 97 - 103. [Abstract] [Full Text] [PDF]

				P. A. Nutting, W. P. Dickinson, L. M. Dickinson, C. C. Nelson, D. K. King, B. F. Crabtree, and R. E. Glasgow Use of Chronic Care Model Elements Is Associated With Higher-Quality Care for Diabetes Ann. Fam. Med, January 1, 2007; 5(1): 14 - 20. [Abstract] [Full Text] [PDF]

				X. Yang, W.-Y. So, A. P.S. Kong, C.-S. Ho, C. W.K. Lam, R. J. Stevens, R. R. Lyu, D. D. Yin, C. S. Cockram, P. C.Y. Tong, et al. Development and Validation of Stroke Risk Equation for Hong Kong Chinese Patients With Type 2 Diabetes: The Hong Kong Diabetes Registry Diabetes Care, January 1, 2007; 30(1): 65 - 70. [Abstract] [Full Text] [PDF]

				D. Jones and W. Curry Impact of a PDA-Based Diabetes Electronic Management System in a Primary Care Office. American Journal of Medical Quality, November 1, 2006; 21(6): 401 - 407. [Abstract] [PDF]

				J. Nagpal and A. Bhartia Quality of Diabetes Care in the Middle- and High-Income Group Populace: The Delhi Diabetes Community (DEDICOM) survey. Diabetes Care, November 1, 2006; 29(11): 2341 - 2348. [Abstract] [Full Text] [PDF]

				P. M. Ho, J. S. Rumsfeld, F. A. Masoudi, D. L. McClure, M. E. Plomondon, J. F. Steiner, and D. J. Magid Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med, September 25, 2006; 166(17): 1836 - 1841. [Abstract] [Full Text] [PDF]

				R. T. Ackermann, T. J. Thompson, J. V. Selby, M. M. Safford, M. Stevens, A. F. Brown, and K.M. V. Narayan Is the Number of Documented Diabetes Process-of-Care Indicators Associated With Cardiometabolic Risk Factor Levels, Patient Satisfaction, or Self-Rated Quality of Diabetes Care?: The Translating Research into Action for Diabetes (TRIAD) study. Diabetes Care, September 1, 2006; 29(9): 2108 - 2113. [Abstract] [Full Text] [PDF]

				A. H. Barnett, M. Dreyer, P. Lange, M. Serdarevic-Pehar, and on behalf of the Exubera Phase III Study Group An Open, Randomized, Parallel-Group Study to Compare the Efficacy and Safety Profile of Inhaled Human Insulin (Exubera) With Glibenclamide as Adjunctive Therapy in Patients With Type 2 Diabetes Poorly Controlled on Metformin Diabetes Care, August 1, 2006; 29(8): 1818 - 1825. [Abstract] [Full Text] [PDF]

				J. C. Zgibor, G. A. Piatt, K. Ruppert, T. J. Orchard, and M. S. Roberts Deficiencies of Cardiovascular Risk Prediction Models for Type 1 Diabetes Diabetes Care, August 1, 2006; 29(8): 1860 - 1865. [Abstract] [Full Text] [PDF]

				K. G. Shojania, S. R. Ranji, K. M. McDonald, J. M. Grimshaw, V. Sundaram, R. J. Rushakoff, and D. K. Owens Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA, July 26, 2006; 296(4): 427 - 440. [Abstract] [Full Text] [PDF]

				C. M. Mangione, R. B. Gerzoff, D. F. Williamson, W. N. Steers, E. A. Kerr, A. F. Brown, B. E. Waitzfelder, D. G. Marrero, R. A. Dudley, C. Kim, et al. The Association between Quality of Care and the Intensity of Diabetes Disease Management Programs Ann Intern Med, July 18, 2006; 145(2): 107 - 116. [Abstract] [Full Text] [PDF]

				J. M. Robbins and D. A. Webb Hospital Admission Rates for a Racially Diverse Low-Income Cohort of Patients With Diabetes: The Urban Diabetes Study Am J Public Health, July 1, 2006; 96(7): 1260 - 1264. [Abstract] [Full Text] [PDF]

				R. W. Grant, E. P. McCarthy, D. E. Singer, and J. B. Meigs Frequent Outpatient Contact and Decreasing Medication Affordability in Patients With Diabetes From 1997 to 2004. Diabetes Care, June 1, 2006; 29(6): 1386 - 1388. [Full Text] [PDF]

				J. B. Saaddine, B. Cadwell, E. W. Gregg, M. M. Engelgau, F. Vinicor, G. Imperatore, and K. M. V. Narayan Improvements in Diabetes Processes of Care and Intermediate Outcomes: United States, 1988-2002 Ann Intern Med, April 4, 2006; 144(7): 465 - 474. [Abstract] [Full Text] [PDF]

				N. Rodondi, T. Peng, A. J. Karter, D. C. Bauer, E. Vittinghoff, S. Tang, D. Pettitt, E. A. Kerr, and J. V. Selby Therapy Modifications in Response to Poorly Controlled Hypertension, Dyslipidemia, and Diabetes Mellitus Ann Intern Med, April 4, 2006; 144(7): 475 - 484. [Abstract] [Full Text] [PDF]

				J. B. Marks A Look Back... and Forward Clin. Diabetes, April 1, 2006; 24(2): 51 - 53. [Full Text] [PDF]

				F. A. McAlister, N. R.C. Campbell, M. Duong-Hua, Z. Chen, and K. Tu Antihypertensive Medication Prescribing in 27,822 Elderly Canadians With Diabetes Over the Past Decade Diabetes Care, April 1, 2006; 29(4): 836 - 841. [Abstract] [Full Text] [PDF]

				I. S. Zagon, J. W. Sassani, and P. J. McLaughlin Insulin treatment ameliorates impaired corneal reepithelialization in diabetic rats. Diabetes, April 1, 2006; 55(4): 1141 - 1147. [Abstract] [Full Text] [PDF]

				T. D. Sequist, A. Adams, F. Zhang, D. Ross-Degnan, and J. Z. Ayanian Effect of quality improvement on racial disparities in diabetes care. Arch Intern Med, March 27, 2006; 166(6): 675 - 681. [Abstract] [Full Text] [PDF]

				W. H. Herman, T. J. Hoerger, K. Hicks, M. Brandle, S. W. Sorensen, P. Zhang, M. M. Engelgau, R. F. Hamman, D. G. Marrero, R. T. Ackermann, et al. Managing People at High Risk for Diabetes Ann Intern Med, January 3, 2006; 144(1): 66 - 67. [Full Text] [PDF]

				R. L. Rothman and T. A. Elasy Can diabetes management programs create sustained improvements in disease outcomes? Can. Med. Assoc. J., December 6, 2005; 173(12): 1467 - 1468. [Full Text] [PDF]

				A. F. Brown, E. W. Gregg, M. R. Stevens, A. J. Karter, M. Weinberger, M. M. Safford, T. L. Gary, D. A. Caputo, B. Waitzfelder, C. Kim, et al. Race, Ethnicity, Socioeconomic Position, and Quality of Care for Adults With Diabetes Enrolled in Managed Care: The Translating Research Into Action for Diabetes (TRIAD) study Diabetes Care, December 1, 2005; 28(12): 2864 - 2870. [Abstract] [Full Text] [PDF]

				M C Marshall Jr Diabetes in African Americans Postgrad. Med. J., December 1, 2005; 81(962): 734 - 740. [Abstract] [Full Text] [PDF]

				P. Hollander, D. Nicewander, C. Couch, D. Winter, J. Herrin, Z. Haydar, and D. J. Ballard Quality of Care of Medicare Patients With Diabetes in a Metropolitan Fee-for-Service Primary Care Integrated Delivery System American Journal of Medical Quality, November 1, 2005; 20(6): 344 - 352. [Abstract] [PDF]

				N. C. Martinez and T. Tripp-Reimer Diabetes Nurse Educators' Prioritized Elder Foot Care Behaviors The Diabetes Educator, November 1, 2005; 31(6): 858 - 868. [Abstract] [Full Text] [PDF]

				A. G. Bertoni, J. K. Kirk, L. D. Case, C. Kay, D. C. Goff Jr, K.M. V. Narayan, and R. A. Bell The Effects of Race and Region on Cardiovascular Morbidity Among Elderly Americans With Diabetes Diabetes Care, November 1, 2005; 28(11): 2620 - 2625. [Abstract] [Full Text] [PDF]

				B. P. Tabaei, W. H. Herman, A. F. Jabarin, and C. Kim Does Diabetes Care Compete With the Provision of Women's Preventive Care Services? Diabetes Care, November 1, 2005; 28(11): 2644 - 2649. [Abstract] [Full Text] [PDF]

				J. E. Aikens, R. Bingham, and J. D. Piette Patient-Provider Communication and Self-care Behavior Among Type 2 Diabetes Patients The Diabetes Educator, September 1, 2005; 31(5): 681 - 690. [Abstract] [Full Text] [PDF]

				J. K Kirk, R. A Bell, A. G Bertoni, T. A Arcury, S. A Quandt, D. C Goff Jr., and K M V. Narayan Ethnic Disparities: Control of Glycemia, Blood Pressure, and LDL Cholesterol Among US Adults with Type 2 Diabetes Ann. Pharmacother., September 1, 2005; 39(9): 1489 - 1501. [Abstract] [Full Text] [PDF]

				E. M. Benjamin Now Is the Time to Improve Quality of Diabetes Care DOC News, August 1, 2005; 2(8): 4 - 4. [Full Text]