The community ecology of diabetes patient classification and practice characteristics

We examined the clinical and epidemiologic characteristics of diabetic subjects ascertained from five different sources (hospital, private practice, specialist practice, nursing home, and prevalence survey) in a medium-sized upstate New York community. Patients were categorized using the National Diabetes Data Group classification (based on weight and insulin requirement) and using an alternative clinical classification scheme based on age at onset and insulin use. Both classifications demonstrate marked differences in the distribution of diabetic subjects. Those seen in general medical practice reflect the prevalent population and tend to have fewer complications and less insulin requirement. Those seen in specialist practice or in hospital have higher complication frequencies. Thus, the source of patients may determine the epidemiologic picture of the disease, as well as the practitioners' perceptions. Use of the clinical classification scheme helps to identify a subgroup of diabetic subjects--those with onset past the age of 25 yr who use insulin--at greatest risk of complications. Further investigation of high-risk groups is warranted, particularly for the implementation and evaluation of diabetes control programs.