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Still 'Room for Improvement' in Preventive Care of Diabetics

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WebMD Health News

Nov. 3, 1999 (Atlanta) -- The American Diabetes Association recommends that the 15.7 million diabetics in the U.S. receive annual eye exams, semi-annual foot exams, and a yearly test showing average blood sugar control. However, many diabetics are not receiving this care. Annual eye examinations for diabetics may be on the rise, but other preventive care for this population lags behind, according to a study conducted in Rhode Island by the CDC and published in the Oct. 29 issue of Morbidity and Mortality Weekly Report.

Complications of diabetes include blindness, kidney failure, heart disease and stroke, painful feet due to nerve damage, and leg and foot amputation. Many studies suggest that preventive care, such as a blood test (called glycosylated hemoglobin) to monitor recent blood sugar control, as well as eye and foot exams can reduce the complications of diabetes and save health care dollars.

"In Rhode Island, the managed care organizations seem to be doing a good job [of providing preventive care], as evidenced by a very high proportion of people getting their eye exams," Venkat Narayan, MD, tells WebMD in an interview. "On the other hand, there are certain other kinds of preventive care practices, like foot exams and annual glycosylated hemoglobin assessments, where there is a lot of room for improvement. Also, ... there are specific target groups that would benefit from these improvements." Narayan was not involved in the study but is chief of the diabetes epidemiology section of the CDC in Atlanta.

Narayan says the findings from Rhode Island, for the most part, support those around the country. "Preventive care practices have varied very widely across managed care organizations," he says. "If there is a surprising finding, it's the fairly high rates of eye exams, suggesting that there have been recent improvements."

This study included about 400 diabetics who were receiving care from a major health maintenance organization (HMO) or major preferred provider organization (PPO) in Rhode Island. Subjects were surveyed to determine how many times in a year a health care provider had conducted a glycosylated hemoglobin, dilated eye examination, and foot examination.

Of the respondents, 54% recalled an annual glycosylated hemoglobin, 87% recalled an annual dilated eye examination, and 58% recalled a semi-annual foot examination. Among patients who were at least 65 years old, over 90% reported eye examinations, but only 48% reported glucose control assessments. Among those 20-44 years old, a higher number of patients (71%) recalled glycosylated hemoglobin tests. These findings may suggest that physicians consider the loss of vision a greater problem in the elderly and glucose control a greater problem for younger adults.

Another finding was that both foot and eye examinations were reported higher in patients on insulin therapy than those not on insulin therapy. Physicians may be using insulin therapy as a marker of more severe diabetic disease and therefore providing more care.

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