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

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Abstract
J R Soc Med 2006;99:463-469 SUMMARY 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. Design Analysis of the nationally-representative surveys Health Survey of England, 2003 (unweighted n=14 057) and the National Health and Nutrition Examination Survey, 2001-2002 (unweighted n=5411). Setting and participants Adults 20-64 years of age; individuals 465. Main outcome measures Glycaemic, lipid and blood pres- sure control and medication use among individuals with previously diagnosed diabetes. Results Among those aged 20-64 the prevalence of diag- nosed diabetes was lower in England (2.7%) than in the USA (5.0%). The proportion with diabetes receiving treatment was similar for the two countries. However, the mean HbA1c in England was 7.6%: in the USA it was 7.5% for those with insurance and 8.6% for those without insurance. The proportion of individuals on ACE inhibitors in England was 39%: in USA it was 39% for those with insurance, and 14% for those without. 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.