Medical care for patients with diabetes. Epidemiologic aspects

To describe the epidemiologic characteristics of physician care and self-care for adults with diabetes in the U.S. population.

Data are drawn from the 1989 National Health Interview Survey, in which a personal household interview was administered to a representative sample of U.S. adults aged 18 years or older. The response rate was 96% (n = 84,572). All subjects identified as having diabetes previously diagnosed by a physician were asked a series of questions about their diabetes. Response rate for this representative sample of U.S. diabetic patients was 95% (n = 2405).

Self-reported information was obtained about various aspects of diabetes care, including care by physicians and self-case practices of the diabetic persons. Sociodemographic and clinical factors that may influence diabetes care were also determined.

More than 90% of diabetic adults had one physician for the usual care of their diabetes, but 32% made fewer than four visits to this physician each year. Most physician visits by diabetic patients were not made to diabetes specialists, and the visit rate to other health care professionals such as ophthalmologists, podiatrists, and nutritionists was low. About half of insulin-treated diabetic subjects used multiple daily insulin injections; and 40% of patients with insulin-dependent diabetes mellitus, 26% of those with non-insulin-dependent diabetes mellitus (NIDDM) who were taking insulin, and 5% of those with NIDDM who were not taking insulin monitored their blood glucose level daily. Diabetes patient education classes had been attended by 35% of diabetic adults.

These and other data indicate that medical care for diabetic patients and their self-care practices may not be optimal for prevention of diabetes complications. The Diabetes Control and Complications Trial showed that achieving and maintaining near-normal glycemia, with a concomitant 50% to 70% reduction in diabetes complications, may require close monitoring and ongoing support from a health care team, ample financial resources, and advanced patient knowledge and motivation. Providing this level of diabetes management to all diabetic persons may require major changes in the health care system and in patient self-care practices.