Diabetes-specific preventive-care practices among adults in a managed-care population - Colorado, Behavioral Risk Factor Surveillance System, 1995

Morbidity and Mortality Weekly Report, Oct 31, 1997

The prevalence of diagnosed diabetes in the United States is 3%; however, diabetes accounts for approximately 15% of total U.S. health-care expenditures (1). Preventive-care practices (e.g., glycemic control and regular foot and ophthalmic examinations) can reduce the occurrence and progression of diabetic complications (2-4). Although managed-care organizations (MCOs) have assessed the use of such practices through chart reviews (5), telephone surveys of MCO patients with diabetes are a less expensive method for collecting accurate data (6). The ongoing, state-based Behavioral Risk Factor Surveillance System (BRFSS) telephone survey can be used to assess levels of care provided by MCOs and self-care practices among persons with diabetes in MCO populations (B). In 1995, a Colorado-based MCO collaborated with the Colorado Diabetes Control Program (CDCP) to use the state-based BRFSS to assess care practices among MCO enrollees. This report presents findings from the CDCP analysis of data on MCO enrollees aged [is greater than or equal to] 30 years who had diabetes; the findings indicate that, although approximately three fourths of enrollees reported most preventive-care practices, two thirds had never heard the term hemoglobin "A-one-C," one fourth had not had their feet examined during the preceding year, and nearly one fifth did not receive an annual dilated-eye examination.

A 12% stratified random sample was selected of 500 MCO enrollees aged [is greater than or equal to] 30 years who had been enrolled for at least 3 years and were receiving care in any one of five main medical facilities operated by the MCO (total eligible: n=4240). Enrollees who had obtained insulin or oral hypoglycemic agents from the MCO pharmacy were considered to have diabetes. The type of diabetes was derived from self-reported data: enrollees were classified as having 1) type 1 diabetes if they were aged [is less than] 30 years when diabetes was diagnosed and were using insulin currently or 2) type 2 diabetes if they were aged [is greater than or equal to] 30 years when diabetes was diagnosed or were not using insulin currently. Self-monitoring of blood glucose (SMBG) and visiting a health-care provider (HCP) for diabetes care at least once during the year preceding the interview were used as indicators of self-care. Awareness of the term hemoglobin "A one C" ([HbA.sub.1c])(*) was used as an indicator of having received diabetes education. Use of [HbA.sub.1c] to monitor long-term glycemic control, foot examinations, and dilated-eye examinations were used as indicators of preventive care received from HCP during the previous year. Level of care was estimated as the percentage of respondents that reported each preventive-care practice. Chi-square tests were used to determine whether insulin use, duration of diabetes, and selected sociodemographic characteristics were associated with level of self-care or HCP-preventive care. Analyses were conducted using Statistical Analysis System (SAS) (7).

Of the 469 (93.8%) persons who participated in the survey, 86.1% were aged [is greater than or equal to] 45 years, 85.3% were white, 53.7% were educated beyond high school, and 54.1% reported having had diabetes for 210 years (Table 1). A total of 349 174.4%) respondents had type 2 diabetes, 66 (14.1%) had type 1, and 54 (11.5%) had diabetes that could not be categorized. Among persons with type 2 diabetes, 253 (72.5%) reported currently using insulin.

TABLE 1. Percentage distribution of selected characteristics among managed-care organization enrollees aged [is greater than or equal to] 30 years who had diabetes-Colorado, 1995

Characteristic                 Sample size     %(*)   (95% Cl
                                                      ([dagger])
Age group (yrs)
  30-44                            62        13.2%    (4.8%-21.6%)
  45-64                           197        42.0%    (35.1%-48.9%)
  [is greater than
    or equal to] 65               207        44.1%    (37.3%-50.9%)
  Unknown                           3         0.6%
Sex
  Men                             236        50.3%    (43.9%-56.7%)
  Women                           229        48.8%    (42.3%-55.3%)
  Unknown                           4         0.9%      --
Race([sections]
  White                           400        80.3%    (81.8%-88.8%)
  Other                            69        14.7%    (6.3%-23.1%)
Education level
  Less than high school diploma    79        16.8%    (8.6%-25.0%)
  High school graduate            137        29.2%    (21.6%-36.8%)
  Some college                    131        27.9%    (20.2%-35.6%)
  College graduate                121        25.8%    (18.0%-33.6%)
  Unknown                           1        0.2%      --
Type of diabetes
  Type 1                           66        14.1%    (5.7%-22.5%)
  Type 2
    Insulin use                   253        53.9%    (47.8%-60.0%)
    No insulin use                 96        20.5%    (12.4%-28.6%)
  Unknown                          54        11.5%    (3.0%-20.0%)
Duration of diabetes (yrs)
    [is less than
      or equal to] 9              162        34.5%    (27.2%-41.8%)
    10-19                         146        31.1%    (23.6%-38.6%)
     [is greater than
       or equal to] 20            108        23.0%    (15.1%-30.9%)
   Unknown                         53        11.3%    (2.8%-19.8%)
Total                             469        100.0%