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Diabetes characteristics types possible harmful complications treatment and the methods of controlli

Abstract 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. 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. The proportion with diabetes receiving treatment was similar for the two countries.

However, the mean HbA1c in England was 7. 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. However, in terms of healthcare there is a substantial difference between the countries with the universal access to care in the UK provided via the National Health Service NHS versus the market-based approach in the USA.

Although some recent studies have compared healthcare activity in the US Health Maintenance Organization, Kaiser Permanente, to the NHS, these studies have been criticized on methodological grounds.

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In addition, there is a potential biases when comparing a privately insured population in the USA with the universal coverage provided by the NHS to all sections of the population in the UK. The purpose of this study was to compare indices of diabetes management between the market-based healthcare system of the USA and the universal access healthcare system in England using nationally representative data.

The HSE is an annual survey based on a nationally representative, probability sampling design for England. The individuals included in this study were aged 20 years and older.

This age range was selected because it corresponded to that previously used in national estimates of diabetes prevalence in the USA. The 2003 HSE included 14 057 unweighted participants. Variables Previously diagnosed diabetes: A diagnosis of diabetes was assessed by asking if a doctor has ever told the respondent that he or she has diabetes.

This categorization has been used in previous studies. At the time of the study, England and the USA used identical criteria for the diagnosis of diabetes, a fasting plasma glucose of 7. Undetected elevated blood glucose: Data from a study of 10 different laboratories indicates that laboratories that use HPLC methods tend to have small variations between them suggesting general comparability in the values.

HbA1c has been used as a population-based screener for diabetes in several studies. The age at which patients were diagnosed with diabetes was available in both surveys. Among those with diagnosed diabetes, the use of insulin or oral medication for diabetes treatment was available in both surveys, and calculated from separate variables for each treatment. Because of the importance of nephropathy as a potential complication of diabetes, and the effectiveness of ACE inhibitors as treatment for the progression of microalbuminuria to nephropathy, we also evaluated the proportion with diagnosed diabetes currently on ACE inhibitors.

We examined glycaemic, lipid and blood pressure control according to prevailing standards in the USA and England at the time of data collection. As with all of the control measures, the American Diabetes Association standards of medical care released in 2000 were considered appropriate for diabetes characteristics types possible harmful complications treatment and the methods of controlli USA because of the 2001-2002 data collection time frame.

For blood pressure we used the mean of these readings. US diabetes patients were considered to have elevated blood pressure when the mean systolic blood pressure greater than 130 mm Hg or diastolic blood pressure greater than 85 mm Hg. In England, mean systolic blood pressure greater than 140 mm Hg or diastolic blood pressure greater than 80 mm Hg was considered elevated.

Although total cholesterol is not a specific target for control in the USA it is incorporated into diabetes management targets in the UK. For the general characterization of the population we subdivided the population into those with public insurance, those with private insurance or no insurance. This was later characterized simply as having health insurance or not.

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

These include age, gender, body mass index BMI and income. Because of the evidence that suggests that access to care is a significant barrier in healthcare delivery independent of socioeconomic status, we utilized the information contained in the NHANES and the HSE regarding self-reported annual income.

To standardize the monetary information across the countries we multiplied British pounds by a constant of 1. Additionally, both surveys provided income estimates standardized to represent poverty levels. Our analysis incorporated both the stratification and clustering aspects of the sampling design. The proper weighting procedures include adjustments for the basic probability of selection and the adjustments for non-response and post-stratification.

Since minorities were oversampled, and a complex sampling design was employed, sampling weights provided by the NHANES were used to compute population estimates based on weighted parameter estimates and standard errors. Our analysis incorporated the sample weights recommended to account for an individual's probability of selection and nonresponse. Analyses were performed for individuals 20-64 years of age.

Thus, the 20-64 age comparison provides population-based evidence of a US market-based healthcare system and a universal access system in England.

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The undetected elevated blood glucose may provide an indication of the amount of undiagnosed diabetes in the population and, therefore, detection differences in the two populations. The prevalence of diagnosed diabetes is lower in England than in the USA among 20-64 year olds: However, adding the undetected proportion to the diagnosed prevalence in England 4. Further, in the USA minorities account for a larger proportion of the population than in England.