US Trends in Receipt of Appropriate Diabetes Clinical and Self-care From 2001 to 2010 and Racial/Ethnic Disparities in Care

Abstract

Purpose

The purpose of this study was to examine trends in the receipt of 8 recommended diabetes clinical and self-care indicators from 2001 to 2010 and assess racial/ethnic disparities in care.

Methods

This observational study examined receipt of A1C tests, annual eye and foot exams, flu vaccination, diabetes self-management education (DSME), exercise, self-monitoring of blood glucose (SMBG), and self feet examinations among US adults with diabetes using national survey data from 2001 to 2010. Analyses included estimating proportions for each indicator by year, testing differences in magnitude of change from 2001 to 2010 by race/ethnicity, and regression models to assess changes in care over time and factors associated with care.

Results

There were significant increases from 2001 to 2010 in A1C tests, annual foot exams, flu shots, DSME, and SMBG but declines in eye and self feet exams. DSME was positively associated with receipt of several care indicators. However, only half of respondents received DSME. White and black non-Hispanics, respectively, experienced improvements in at least 3 indicators. Hispanics experienced a significant increase in exercise but were consistently less likely than whites to receive or engage in most care.

Conclusions

While improvements in several indicators were observed, patterns varied by race/ethnicity, with Hispanics falling short on most measures. DSME was strongly associated with most care and demonstrates the potential to improve receipt of recommended care by increasing DSME participation. With the Affordable Care Act (ACA), health professionals have a prime opportunity to leverage ACA provisions to increase access to recommended services, including DSME.

Get full access to this article

View all access options for this article.

References

National Diabetes Information Clearinghouse. National diabetes statistics, 2011. 2011; NIH Publication No. 11-3892.http://diabetes.niddk.nih.gov/dm/pubs/statistics/#Racial. Accessed April 10, 2014.

Centers for Disease Control & Prevention. Diabetes Report Card 2012. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2012.

Office of Minority Health. Diabetes and African Americans. http://minorityhealth.hhs.gov/templates/content.aspx?lvl=3&lvlID=5&ID=3017. Accessed April 10, 2014.

Office of Minority Health. Diabetes and American Indians/Alaska Natives. http://minorityhealth.hhs.gov/templates/content.aspx?lvl=3&lvlID=5&ID=3024. Accessed April 10, 2014.

Office of Minority Health. Diabetes and Asians and Pacific Islanders. http://minorityhealth.hhs.gov/templates/content.aspx?lvl=3&lvlID=5&ID=3057. Accessed April 10, 2014.

Office of Minority Health. Diabetes and Hispanic Americans. http://minorityhealth.hhs.gov/templates/content.aspx?lvl=3&lvlID=5&ID=3324. Accessed April 10, 2014.

National Diabetes Information Clearinghouse. Diabetes overview. NIH Publication No. 09–3873. http://www.diabetes.niddk.nih.gov/dm/pubs/overview/. Accessed April 10, 2014.

American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36(4):1033-1046.

Agency for Healthcare Research and Quality. 2012 national healthcare disparities report. June 2013. http://www.ahrq.gov/research/findings/nhqrdr/nhdr12/chap2a.html#diabetes. Accessed July 30, 2013.

10.

American Diabetes Association. Standards of medical care in diabetes—2010. Diabetes Care. 2010;33(suppl 1):S11-S61.

11.

Klein

. Healthy People 2010 Statistical Notes. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Health Statistics; 2001.

12.

Andersen

. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1-10.

13.

Agency for Healthcare Research and Quality. Self-management programs for patients with diabetes have a positive impact: chronic disease. http://www.ahrq.gov/news/newsletters/research-activities/13mar/0313RA8.html. Accessed March 10, 2014.

14.

Rothman

. No adjustments are needed for multiple comparisons. Epidemiology. 1990;1(1):43-46.

15.

Centers for Disease Control & Prevention. Behavioral risk factor surveillance system. http://cdc.gov/brfss/. Accessed May 13, 2014.

16.

Behavioral Risk factor surveillance system: survey data and documentation. http://www.cdc.gov/brfss/data_documentation/index.htm. Accessed April 13, 2014.

17.

Ali

Bullard

Saaddine

Cowie

Imperatore

Gregg

. Achievement of goals in U.S. diabetes care, 1999–2010. N Engl J Med. 2013;368(17):1613-1624.

18.

Nutting

Dickinson

. Use of chronic care model elements is associated with higher-quality care for diabetes. Ann Fam Med. 2007;5(1):14-20.

19.

Ory

Ahn

Jiang

. Successes of a national study of the Chronic Disease Self-Management Program: meeting the triple aim of health care reform. Med Care. 2013;51(11):992-998.

20.

Department of Health and Human Services (DHHS), Health Care Financing Administration (HCFA). Expanded Coverage of Diabetes Outpatient Self-Management Training (Program Memorandum. Transmittal B-01-40, Change Request 1455, June 15, 2001).

21.

Manning

Newhouse

Duan

Keeler

Leibowitz

. Health insurance and the demand for medical care: evidence from a randomized experiment. Am Econ Rev. 1987;3:251-277.

22.

O’Connor

Desai

Rush

Cherney

Solberg

Bishop

. Is having a regular provider of diabetes care related to intensity of care and glycemic control? J Fam Pract. 1998;47(4):290-297.

23.

Parchman

Pugh

Noël

Larme

. Continuity of care, self-management behaviors, and glucose control in patients with type 2 diabetes. Med Care. 2002;40(2):137-144.

24.

Lorig

Ritter

Ory

Whitelaw

. Effectiveness of a generic chronic disease self-management program for people with type 2 diabetes: a translation study. Diabetes Educ. 2013;39(5):655-663.

25.

Steinsbekk

Rygg

Lisulo

Rise

Fretheim

. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res. 2012;12:213.

26.

Peyrot

Rubin

. Access to diabetes self-management education. Diabetes Educ. 2008;34(1):90-97.

27.

Munshi

Segal

Suhl

. Assessment of barriers to improve diabetes management in older adults: a randomized controlled study. Diabetes Care. 2013;36(3):543-549.

28.

Mathew

Gucciardi

De Melo

Barata

. Self-management experiences among men and women with type 2 diabetes mellitus: a qualitative analysis. BMC Fam Pract. 2012;13:122.

29.

Salmela

Vahasarja

Villberg

. Perceiving need for lifestyle counseling: findings from Finnish individuals at high risk of type 2 diabetes. Diabetes Care. 2012;35(2):239-241.

30.

Centers for Disease Control & Prevention. National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention;2011.

31.

Crowley

Bosworth

Coffman

. Tailored Case Management for Diabetes and Hypertension (TEACH-DM) in a community population: study design and baseline sample characteristics. Contemp Clin Trials. 2013;36(1):298-306.

32.

Leeman

Skelly

Burns

Carlson

Soward

. Tailoring a diabetes self-care intervention for use with older, rural African American women. Diabetes Educ. 2008;34(2):310-317.

33.

Bulger

Shubrook

Snow

. Racial disparities in African Americans with diabetes: process and outcome mismatch. Am J Manag Care. 2012;18(8):407-413.

34.

Documet

Sharma

. Latinos’ health care access: financial and cultural barriers. J Immigr Health. 2004;6(1):5-13.

35.

Juckett

. Caring for Latino patients. Am Fam Physician. 2013;87(1):48-54.

36.

Kempf

Remington

. New challenges for telephone survey research in the twenty-first century. Annu Rev Public Health. 2007;28:113-126.

37.

Lee

Brick

Brown

Grant

. Growing cell-phone population and noncoverage bias in traditional random digit dial telephone health surveys. Health Serv Res. 2010;45(4):1121-1139.

38.

Link

Mokdad

Stackhouse

Flowers

. Race, ethnicity, and linguistic isolation as determinants of participation in public health surveillance surveys. Prev Chronic Dis. 2006;3(1):A09.

39.

Schneider

Clark

Rakowski

Lapane

. Evaluating the impact of non-response bias in the Behavioral Risk Factor Surveillance System (BRFSS). J Epidemiol Community Health. 2012;66(4):290-295.