Are the US territories lagging behind in diabetes care practices?

• Type of Material: Article
• Authors: Rachel P Ogilvie, University of Pittsburgh; Shivani Patel, Emory University; Kabayam Venkat Narayan, Emory University; Neil Mehta, Emory University
• Language: English
• Date: 2018-10-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Primary Care Diabetes Europe CC BY NC ND 4.0
• Final Published Version (URL): http://dx.doi.org/10.1016/j.pcd.2018.04.005
• Title of Journal or Parent Work: Primary Care Diabetes
• ISSN: 1751-9918
• Volume: 12
• Issue: 5
• Start Page: 432
• End Page: 437
• Grant/Funding Information: This work was supported by the National Institutes of Health (grants T32 HL007779, T32 HL082610, and P30DK111024) and the Robert Wood Johnson Foundation (grant 70769).
• Keywords: Diabetes; UNITED-STATES; US territories or disparities; Endocrinology & Metabolism; SERVICES; Primary Health Care; QUALITY; Life Sciences & Biomedicine; General & Internal Medicine; Science & Technology; Epidemiology; FACTOR SURVEILLANCE SYSTEM; ADULTS; BEHAVIORS; SELF-MANAGEMENT; Healthy People 2020
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

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.