TUESDAY, April 16, 2002 (HealthDayNews) -- Two new studies could change how diabetes is diagnosed and treated.
One says Americans with diabetes aren't receiving the best care for their disease, while another suggests a mathematical model performs as well as the standard oral glucose tolerance test in predicting a person's risk of developing Type II diabetes.
Both reports appear in today's issue of the Annals of Internal Medicine.
In the first study, scientists at the National Center for Chronic Disease Prevention and Health Promotion used data from two national surveys to analyze the quality of diabetes care in the United States during the early 1990s.
The first, the Third U.S. National Health and Nutrition Examination Survey (NHANES III) ran from 1988 to 1994, and the second, from the Behavioral Risk Factors Surveillance System (BRFSS), gathered information in 1995. All the people in the study, 1,026 from NHANES III and 3,059 from BRFSS, were between 18 and 75 years old and had been diagnosed with diabetes.
The research examined data gathered in the surveys, including blood sugar levels, blood pressure and cholesterol levels. It found that 18 percent of people with diabetes had inadequate blood sugar control, 34 percent had poor blood pressure control and 58 percent had insufficient cholesterol control.
Moreover, 37 percent did not have annual eye exams, which are essential for catching glaucoma, cataracts or retina conditions associated with diabetes. Another 45 percent did not have annual foot exams, in which doctors look for signs of foot ulcers, nerve damage or poor circulation. According to lead investigator Dr. Jinan B. Saaddine, diabetes is the leading cause of blindness and lower extremity amputation.
Previous studies have found that preventive care for Type II diabetes varies widely from state to state, with use of care highest in the Northeast and lowest in the southern states. Research has consistently shown that people without health insurance are the least likely to receive preventive care for their diabetes. However, until now, experts didn't have a national picture of diabetes care.
Saaddine, a medical epidemiologist, says that while certain minorities appear to receive the worst levels of care, the findings reveal poor levels of care across all groups.
"There is a huge gap between the recommended care and the care that patients are receiving," she says. "We need to address this to get better health for people with diabetes."
Saaddine says closing the gap will most likely involve dealing with problems at the patient, provider and health-care system levels. While ongoing studies are looking at barriers to optimal care, "[patients] need to feel more empowered. They need to really be involved in the decision-making
and be educated about their disease," she says.
However, there's hope, says American Diabetes Association President-elect Dr. Francine R. Kaufman.
Kaufman, a pediatric endocrinologist at Children's Hospital Los Angeles, predicts the next round of data will show an improvement. "We've been hauled into the principal's office, and we're doing better," she says.
She adds that public and physician education programs have been working hard to spread the word about the importance of diabetes care, and surveillance systems are now monitoring whether doctors and managed-care groups are providing sufficient diabetes-related tests.
Kaufman stresses that Type II diabetes, once a disease confined to the elderly, now affects adults and children as well.
"We have to really make some effort across this huge spectrum of the population, involving all of the ethnic groups, to be sure that the word is out as to what quality of care really is," Kaufman says.
The second study, by researchers at the University of Texas Health Science Center, suggests a simple mathematical model performs as well as the standard oral glucose tolerance (OGT) test in predicting a person's risk of developing Type II diabetes.
Along with his colleagues, statistician Ken Williams collected data on blood pressure, medical history and sugar levels after fasting and during an OGT test for 1,791 Mexican Americans and 1,112 whites. None had diabetes, and all were checked again 7.5 years later.
Williams then compared the predictive accuracy of three models: one that included only the OGT test results; one that used only the other clinical data; and a third that combined both the clinical information and the OGT test data.
For OGT data alone, the predictive accuracy was 77.5 percent, while the clinical data's predictive accuracy reached 84.3 percent. If both were used together, the predictive accuracy peaked at 85.7 percent.
"Physicians can do a better job of assessing risk for developing diabetes by looking at the variety of indicators at their disposal from a standard physical exam than they can by focusing entirely on the results of an oral glucose tolerance test," Williams says.
Williams adds patients might also prefer the mathematical model over the OGT test, which requires that they fast for 12 hours, take a blood test, then wait at their medical provider's office for another two hours for another blood test. "That costs the patient two hours of their time," Williams says.
If everyone who qualifies for screening under the latest standards had OGT tests including most minorities, non-Hispanic whites over 45, and younger non-Hispanic whites with certain risk factors the indirect cost of lost work hours could be $1.16 billion to $3.08 billion, the researchers say.
What to Do: Find out about the risk factors for diabetes from the American Diabetes Association, the National Institute of Diabetes & Digestive & Kidney Diseases or the Juvenile Diabetes Research Foundation.
