Improvements in Diabetes Care in the United States, 1988–2002

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.

The summary below is from the full report titled "Improvements in Diabetes Processes of Care and Intermediate Outcomes: United States, 1988–2002." It is in the 4 April 2006 issue of Annals of Internal Medicine (volume 144, pages 465-474). The authors are J.B. Saaddine, B. Cadwell, E.W. Gregg, M.M. Engelgau, F. Vinicor, G. Imperatore, and K.M. Venkat Narayan.

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

Diabetes mellitus interferes with the body's ability to store energy from food. The pancreas makes insulin, a substance 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 cannot use it normally. In both types, 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 levels under control can prevent the development of complications. The control of blood pressure and cholesterol levels is also very important for patients with diabetes. Because these can be accomplished with good care, it is important to know about the general quality of diabetes care in the United States. In 2002, researchers reported on the quality of diabetes care in the United States for the years 1988 to 1995. At that time, they noted that it would be valuable to check the general quality of diabetes care in the United States every few years to see whether care was improving.

Why did the researchers do this particular study?

To see whether the care that Americans with diabetes receive has improved between 1988 and 2002.

Who was studied?

The researchers used information from 2 national surveys that are repeated every few years. In the National Health and Nutrition Examination Survey, samples of adults with diabetes answered a survey about health and nutrition in 1988–1994 and again in 1999–2002. In the Behavioral Risk Factor Surveillance System, patients with diabetes answered questions about health behaviors in 1995 and in 2002.

How was the study done?

The researchers used the information in the surveys to estimate the numbers of Americans with diabetes who had adequate control of blood sugar, blood pressure, and cholesterol levels and who had recommended yearly eye and foot examinations at the time of each survey. They then compared the earlier and later time periods.

What did the researchers find?

Over the past decade, the proportion of Americans with diabetes who have good cholesterol control has substantially improved. Improvements in the other measures of diabetes care have been smaller (blood sugar control, yearly eye and foot examinations, influenza vaccine, and aspirin use) or did not occur (poor blood sugar or blood pressure control). Despite the improvements, 2 of every 5 American adults with diabetes have poor cholesterol control, 1 of every 3 has poor blood pressure control, and 1 of every 5 has poor blood sugar control.

What were the limitations of the study?

The study used information from before 2002 and may not reflect the quality of care in more recent years. This study does not tell us why care did not meet goals.

What are the implications of the study?

Despite some improvements over the past decade, many Americans with diabetes receive care that falls short of the recommended treatment goals for diabetes.