Chart Carts

0 snapshots in My Collection

Diabetes Management

How many adults with diabetes receive tests to help prevent disease complications, and how many achieve control of their disease?

In 2002, little more than one-half (53%) of community-dwelling adults with diabetes reported receiving three recommended tests (for blood sugar control and eye and foot problems) in the past year to help prevent disease complications. State performance on a similar but more rigorous measure (receipt of at least two tests for blood sugar control and an eye and foot exam in the past year) ranged from 32 percent to 64 percent during 2002–2004. Nationally, only 42 percent to 68 percent of adults with diabetes achieved control of diabetes and cardiovascular risk factors during 1999–2002.

Slide For Diabetes Management
Slide For Diabetes Management
Slide For Diabetes Management


Why is this important?

  • Diabetes is the sixth-leading cause of death in the U.S. The number of Americans with diagnosed diabetes grew by 50 percent from 10.1 million in 1997 to 15.2 million in 2004 (CDC 2006), a trend that has been linked with rising obesity (Geiss et al. 2006). Diabetes prevalence increases with age and affects about one of five older adults (NIDDKD 2005).
  • Treatment for diabetes and its complications costs $92 billion annually (Hogan et al. 2003). Complications include eye disease, kidney disease, nerve damage, and cardiovascular disease that can lead to blindness, kidney failure, heart attacks, and strokes.
  • Diabetes complications can be substantially reduced through appropriate disease management including annual eye and foot examinations along with regular monitoring and control of blood sugar levels, cholesterol levels, and blood pressure (ADA 2006; DCCT Research Group 1993; UK Prospective Diabetes Study Group 1998a, 1998b; Vijan and Hayward 2004).

Findings

  • Almost one-half of community-dwelling adults with diabetes (ages 18 and older) did not receive three recommended preventive tests (at least one hemoglobin A1c test to check blood sugar control, a retinal exam to check for diabetic eye disease, and a foot exam to check for nerve damage) in 2002, with slight improvement (4 percentage points) from 2000.
  • In the state (Hawaii) with the best performance on a more rigorous measure (receipt of at least two hemoglobin A1c tests and an eye and foot exam in the past year), one-third did not receive all four tests in a one-year period during 2002–2004. In the state (Nevada) with the worst performance on this measure, two-thirds did not receive all four tests.

Implications

  • Although the nation appears close to achieving Healthy People 2010 goals that 75 percent of diabetic adults receive an annual eye or foot examination, there is still a large performance gap in ensuring that patients receive all the recommended preventive services.
  • Improving diabetes control can reduce hospitalizations, improve patients' quality of life, increase employment retention and workplace productivity, and be cost-saving if sustained over time (Testa and Simonson 1998).

Improvement Ideas and Resources

Diabetic patients who visit their physician regularly and report a collaborative relationship with their physician are more likely to receive preventive services and achieve better outcomes (Fenton et al. 2006; Rubin 2006).Systematic reviews of quality improvement studies have found that multifaceted approaches can improve clinician compliance with guidelines and patient outcomes of care (Renders et al. 2001; Shojania et al. 2004). Common elements include:

  • Educating patients and health professionals to improve adherence;
  • Tracking patients and sending reminders for follow-up care and missed appointments;
  • Prompting physicians to deliver recommended services;
  • Providing physicians with feedback on their performance; and
  • Involving nurses and multidisciplinary teams in patient education and care.
The National Diabetes Education Program provides resources and tools for use by health professionals, educators, businesses, and health plans to help reduce the development and progression of diabetes.

Measure:

The denominator for the charts is community-dwelling adults (ages 18 and older for services and ages 18 to 75 for outcomes) with self-reported diagnosed diabetes. The numerator is the subset of the denominator who reported that they received selected services, or who achieved selected outcomes based on standardized physical and laboratory values, as specified in consensus measures endorsed by the National Diabetes Quality Improvement Alliance (NDQIA 2005). National service use rates were age-adjusted to the 2000 U.S. standard population (AHRQ 2006).

Limitations:

National rates reflect one or more hemoglobin A1c tests, whereas state rates reflect two or more A1c tests. Process measures do not include all recommended services, such as lipid testing, microalbumin testing, or vaccinations. Process measures are based on self-reported data, which are subject to potential recall bias and may overstate the rate of compliance compared to records-based data sources (Fowles et al. 1999).

Source: