Diabetes management in the USA and England: comparative analysis of national surveys.

OBJECTIVES To compare diabetes management in adults between England and the United States, particularly focusing on the impact of a universal access health insurance system. DESIGN Analysis of the nationally-representative surveys Health Survey of England, 2003 (unweighted n =14 057) and the National Health and Nutrition Examination Survey, 2001-2002 (unweighted n =5411). SETTING AND PARTICIPANTS Adults 20-64 years of age; individuals >65. MAIN OUTCOME MEASURES Glycaemic, lipid and blood pressure control and medication use among individuals with previously diagnosed diabetes. RESULTS Among those aged 20-64 the prevalence of diagnosed diabetes was lower in England (2.7%) than in the USA (5.0%). The proportion with diabetes receiving treatment was similar for the two countries. However, the mean HbA1c in England was 7.6%: in the USA it was 7.5% for those with insurance and 8.6% for those without insurance. The proportion of individuals on ACE inhibitors in England was 39%: in USA it was 39% for those with insurance, and 14% for those without. CONCLUSIONS Individuals in a healthcare system providing universal access have better managed diabetes than those in a market based system once one accounts for insurance.

[1]  R. Klein.  Universal Health Care : Lessons From the British Experience , 2002 .

[2]  A. Zbrozek,et al.  Model of Complications of NIDDM: II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia , 1997, Diabetes Care.

[3]  R. Feachem,et al.  Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente. , 2002, BMJ.

[4]  D. Snider,et al.  Prevalence of diabetes and impaired fasting glucose in adults--United States, 1999-2000. , 2003, MMWR. Morbidity and mortality weekly report.

[5]  Standards of Medical Care for Patients With Diabetes Mellitus , 1993, Diabetes Care.

[6]  R. Koopman,et al.  Relationship between continuity of care and diabetes control: evidence from the Third National Health and Nutrition Examination Survey. , 2004, American journal of public health.

[7]  A. Pollock,et al.  Questioning the claims from Kaiser. , 2004, The British journal of general practice : the journal of the Royal College of General Practitioners.

[8]  Standards of Medical Care for Patients With Diabetes Mellitus , 1998, Diabetes Care.

[9]  R. Hanson,et al.  Comparison of screening tests for non-insulin-dependent diabetes mellitus. , 1993, Archives of internal medicine.

[10]  Steffie Woolhandler,et al.  Getting more for their dollar: Kaiser v the NHS: Price adjustments falsify comparison , 2002, BMJ : British Medical Journal.

[11]  Nick York,et al.  Hospital bed utilisation in the NHS, Kaiser Permanente, and the US Medicare programme: analysis of routine data , 2003, BMJ : British Medical Journal.

[12]  Griffin,et al.  The performance of a risk score in predicting undiagnosed hyperglycemia. , 2002, Diabetes care.

[13]  R. Cohen,et al.  Health Insurance Coverage: Estimates from the National Health Interview Survey, January - March 2004 , 2004 .

[14]  L. Brown.  Comparing health systems in four countries: lessons for the United States. , 2003, American journal of public health.

[15]  C. Weykamp,et al.  Glycohaemoglobin: Comparison of 12 Analytical Methods, Applied to Lyophilized Haemolysates by 101 Laboratories in an External Quality Assurance Programme , 1993, Annals of clinical biochemistry.

[16]  K. Flegal,et al.  Use of GHb (HbA1c) in screening for undiagnosed diabetes in the U.S. population. , 2000, Diabetes care.

[17]  Martin Roland,et al.  Linking physicians' pay to the quality of care--a major experiment in the United kingdom. , 2004, The New England journal of medicine.

[18]  T. Dudley,et al.  Utility of hemoglobin A1c in predicting diabetes risk , 2004, Journal of General Internal Medicine.

[19]  R. Koopman,et al.  Continuity of care and recognition of diabetes, hypertension, and hypercholesterolemia. , 2003, Archives of internal medicine.

[20]  K. Flegal,et al.  Prevalence of Diabetes, Impaired Fasting Glucose, and Impaired Glucose Tolerance in U.S. Adults: The Third National Health and Nutrition Examination Survey, 1988–1994 , 1998, Diabetes Care.