A diabetes report card for the United States: quality of care in the 1990s

Background: Improving diabetes care in the United States is a topic of concern. Objective: To document the quality of diabetes care during 1988-1995. Design: National population-based cross-sectional surveys. Setting: Third U.S. National Health and Nutrition Examination Survey (NHANES III)(1988-1994) and the Behavioral Risk Factors Surveillance System (BRFSS)(1995). Participants: Participants in NHANES III (n=1026) or BRFSS (n=3059) who were 18 to 75 years of age and reported a physician diagnosis of diabetes. Women with gestational diabetes were excluded. Measurements: Glycemic control, blood pressure, low-density lipoprotein (LDL) cholesterol level, biannual cholesterol monitoring, and annual foot and dilated eye examination, as defined by the Diabetes Quality Improvement Project. Results: 18.0% of participants (95% CI, 15.7% to 22.3%) had poor glycemic control (hemoglobin A(sub 1c) level >9.5%), and 65.7% (CI, 62.0% to 69.4%) had blood pressure less than 140/90 mm Hg. Cholesterol was monitored biannually in 85.3% (CI, 83.1% to 88.6%) of participants, but only 42.0% (CI, 34.9% to 49.1%) had LDL cholesterol levels less than 3.4 mmol/L ( Conclusions: According to U.S. data collected during 1988-1995, a gap exists between recommended diabetes care and the care patients actually receive. These data offer a benchmark for monitoring changes in diabetes care.