(HealthScout). Americans with diabetes aren't
receiving preventive treatments as often or as thoroughly as they
should, a new study says.
Despite a variety of outreach efforts, preventive
care for adults with non-insulin dependent diabetes (Type II) differs
vastly depending on factors like age, race and income, according
to the government scientists who prepared the report.
The findings, which are intended to be a benchmark
for education efforts in the coming decade, show that "it's pretty
clear there's plenty of room for improvement," says Edward Tierney,
an epidemiologist at the Centers for Disease Control and Prevention
in Atlanta and a co-author of the study.
"Some people feel that you can't do anything about
diabetes. Our take on that is that [patients] can do something about
it to either delay or prevent the onset of complications. You can
be in control, you can improve your outcome, but it's going to take
work."
More than 15 million Americans have diabetes. Most
have the adult-onset, or Type II, form of the condition, in which
their cells lose their sensitivity to the hormone insulin, which
helps the body extract sugar from blood.
The number of Americans with diabetes rose 33 percent
between 1990 and 1998, the CDC says, thanks largely to a jump in
how fat people are becoming.
Although diabetes can be easily controlled -- with
drugs, regular injections of insulin, changes in diet and exercise
-- if unchecked it can cause serious health problems and even death.
Diabetes is the leading cause of adult blindness and
a major source of kidney, heart and vessel disease, health officials
say. Nerve damage from the condition leads to more than 56,000 amputations
a year, half of which could be prevented, experts say.
The study, based on a phone survey between 1997 and
1999, focused on several key measures of preventive treatment for
diabetics: blood sugar self-testing, eye exams to watch for signs
of blindness linked to the disease, and foot exams to catch nerve
and tissue damage that can lead to amputation. They also looked
at rates of another blood test, for a protein called HbA1C, which
marks the progress of the disease.
For all gauges, the average percentages of diabetics
who reported receiving these tests were far below the health goals
set for the year 2010, which themselves stop below 80 percent of
all patients.
Sugar monitoring rates ranged from about 30 percent
of people surveyed in Hawaii, to 65.5 percent in Montana -- the
only state to meet the 2010 goal of 60 percent. The percentage of
people receiving yearly eye exams ranged from 47 percent in Arkansas
to 81 percent in Massachusetts, one of just three states to meet
the 2010 guideline of 75 percent for this test.
No state met the 2010 yardsticks for either annual
foot exams or the HbA1C screening.
The use of preventive care ranged widely from state
to state, but was generally low in the south and higher in the northeast,
the researchers say. Age was a factor, too. People over 45 were
more likely to have an annual eye exam, while those over 75 were
less likely to check their own blood sugar, the study found.
"It's really not clear from our data why some states
are lower that others," Tierney says. Possible factors include differences
in demographics, attitudes among patients, variations in the way
doctors practice medicine, and social and economic forces, he says.
Not surprisingly, patients without health insurance were less likely
to report getting preventive care for their diabetes.
Martha Funnell, a diabetes expert at the University
of Michigan in Ann Arbor and vice president for health care and
education at the American Diabetes Association, calls the latest
findings "discouraging," but says simply taking stock of the problem
is a good start at curing it.