Disparities and Decline

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It’s no secret that cases of diabetes, especially Type 2 diabetes, are on the rise. According to the American Diabetes Association, in 2010, 1.9 million new cases of diabetes were diagnosed among people age 20 or older in the United States — leading to a total of 18.8 million people diagnosed with the condition, in addition to an estimated 7 million who have diabetes but don’t know it yet. Together, this group represents 8.3% of the US population. Under current trends, however, that number is projected to rise to 25% of the population by 2050 — and possibly even higher if diabetes-related deaths can be reduced.

Against this backdrop, it is clear that providing adequate care to everyone with diabetes is a challenge that will only grow over time. But according to a report issued earlier this year by the Agency for Healthcare Research and Quality (AHRQ), a division of the US Department of Health and Human Services, there has been a decline in delivery of recommended health services to certain groups of people with diabetes in recent years. Of adults age 40 or older with diabetes, the percentage that received an HbA1c test, a dilated eye examination, and a foot examination in a given year declined overall between 2002 and 2007. But this decline was most pronounced in certain groups: Among low-income people, the percentage dropped from 39% to 21%; among African-Americans, from 43% to 32%; and among Hispanic Americans, from 34% to 27%. The drop among white Americans was from 43% to 39%. The only group — by race or by income — that saw no decline was high-income people, among whom the percentage fluctuated slightly but both started and ended at 52%.

Not all trends in the report, however, were dismal. Hospital admissions for short-term diabetic complications (such as diabetic ketoacidosis and severe hypoglycemia) stayed relatively steady in all racial and income groups. The percentage of African-Americans and Mexican Americans with an HbA1c level below 7% rose over the study period (it fell slightly among white Americans), as did the percentage of all racial groups with total blood cholesterol below 200 mg/dl. The rate of lower extremity amputations also fell between 1999 and 2007 among both African-Americans and white Americans.

Have you noticed any deterioration or improvement in the quality of your diabetes care? Do you have any idea what factors might explain the decline in delivery of recommended health services to people with diabetes? How might this trend be reversed — with better diabetes education, or more doctors? What efforts might reduce the disparities — in both care received and clinical outcomes — seen among racial and income groups? Leave a comment below!

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