Highlights
- •Three U.S. territories consistently lagged the U.S. states in diabetes care.
- •Healthy People 2020 objectives for diabetes care are not being met.
- •Disparities in diabetes care practices need to be addressed.
Abstract
Aims
Although U.S. territories fall within the mandate outlined by Healthy People 2020,
they remain neglected in diabetes care research. We compared the prevalence and secular
trends of four recommended diabetes care practices in the U.S. territories of Guam,
Puerto Rico, and the U.S. Virgin Islands to the 50 United States and D.C. (“U.S. States”)
in 2001–2015.
Methods
Data were from 390,268 adult participants with self-reported physician diagnosed diabetes
in the Behavioral Risk Factor Surveillance System. Diabetes care practices included
biannual HbA1c tests, attendance of diabetes education classes, daily self-monitoring
of blood glucose, and receipt of annual foot examination. Practices were compared
by U.S. territory and between territories and U.S. states. Multivariable models accounted
for age, sex, education, and year.
Results
Of adults with diagnosed diabetes, 7% to 11% in the U.S. territories engaged in all
four recommended diabetes care practices compared with 25% for those, on average,
in U.S. states. Relative to the U.S. states, on average, the proportion achieving
biannual HbA1c testing was lower in Guam and the U.S. Virgin Islands (45.6% and 44.9%
vs. 62.2%), while annual foot examinations were lower in Puerto Rico (45.9% vs 66.1%
in the U.S. states). Diabetes education and daily glucose self-monitoring were lower
in all three territories.
Conclusions
U.S. territories lag behind U.S. states in diabetes care practices. Policies aimed
at improving diabetes care practices are needed in the U.S. territories to achieve
Healthy People 2020 goals and attain parity with U.S. states.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Primary Care DiabetesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Surveillance for certain health behaviors, chronic diseases, and conditions, access to health care, and use of preventive health services among states and selected local areas—behavioral risk factor surveillance system, United States, 2012.MMWR Surveill. Summ. 2016; 65: 1-142
- Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control.Diabetes Care. 2002; 25: 1159-1171
- Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial.Ann. Intern. Med. 1993; 119: 36-41
- Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).Lancet. 1998; 352: 837-853
- A diabetes report card for the United States: quality of care in the 1990s.Ann. Intern. Med. 2002; 136: 565-574
- Population-based assessment of the level of care among adults with diabetes in the U.S.Diabetes Care. 1998; 21: 1432-1438
- Are persons with diabetes practicing healthier behaviors in the year 2001? Results from the behavioral risk factor surveillance system.Prev. Med. 2004; 38: 203-208
- Improvements in diabetes processes of care and intermediate outcomes: United States, 1988–2002.Ann. Intern. Med. 2006; 144: 465-474
- Preventive-care practices among adults with diabetes—Puerto Rico, 2000–2002.MMWR Morb. Mortal. Wkly Rep. 2004; 53: 1047-1050
- Prevalence of the metabolic syndrome in San Juan, Puerto Rico.Ethn. Dis. 2008; 18: 434-441
- Diabetes-related preventive-care practices—Guam, 2001–2003.MMWR Morb. Mortal. Wkly Rep. 2005; 54: 333-335
- Reliability and validity of measures from the behavioral risk factor surveillance system (BRFSS).Soz. Praventivmed. 2001; 46: S3-S42
- Diabetes preventive services and policy implications in the U.S.Diabetes Care. 2011; 34: 8-13
Centers for Medicare and Medicaid Services, 2017. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Core-Measures.html.
- Incidence of type 1 and type 2 diabetes in youth in the US Virgin Islands, 2001–2010.Pediatr. Diabetes. 2013; 14: 280-287
Guam Economic Development Authority Bureau of Statistics and Plans. Guam Comprehensive Economic Development Strategy (CEDS), 2011.
- An assessment of non-communicable diseases, diabetes, and related risk factors in the territory of guam: a systems perspective.Hawai'i J. Med. Public Health: J. Asia Pac. Med. Public Health. 2013; 5: 68-76
- Self-management among patients living with diabetes in the United States Virgin Islands.J Health Care Poor Underserved. 2011; 22: 271-283
- Healthcare disparities affecting Americans in the US territories: a century-old dilemma.Am. J. Med. 2017; 130: e39-e42
- Quality of care in the US territories.Arch. Intern. Med. 2011; 171: 1528-1540
Article info
Publication history
Published online: May 09, 2018
Accepted:
April 16,
2018
Received in revised form:
March 29,
2018
Received:
October 12,
2017
Identification
Copyright
© 2018 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
