Health-care providers are missing many opportunities to reduce the burden of diabetes through improved control of blood glucose levels and improved diagnosis and treatment of arterial hypertension and hypercholesterolemia.

“A substantial proportion of individuals with diabetes remain undiagnosed and untreated, both in developed and developing countries,” researchers found. “These figures range from 24% of the women in Scotland and the USA to 62% of the men in Thailand” (Bull World Health Organ. 2011;89:172-183, accessed March 15, 2011).

Health-examination surveys were used to explore diagnosis; treatment; and control of glucose, BP, and cholesterol levels among persons with diabetes in the United States, Colombia, England, Iran, Mexico, Scotland, and Thailand. In the United States alone, nearly 90% of adults with diabetes—more than 16 million adults aged 35 and older—have unhealthful levels of glucose, BP, and cholesterol. Only about 12% of U.S. males are reaching the appropriate treatment targets.

The authors recommend three strategies to improve the management of diabetes in the short term: (1) make a greater effort to standardize and track the care of persons with diabetes and provide clear targets for providers and patients; (2) offer incentives to providers and patients that are tied to blood-glucose outcomes rather than process measures; and (3) make more technological innovations in diabetes care (e.g., blood-glucose monitoring and drug delivery).

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Another recent study focusing diabetes and geography identified a U.S. “diabetes belt”—clustered high-prevalence areas for the disease (Am J Prev Med. 2011;40:434-439). The belt comprises 644 counties in portions of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia, plus all of Mississippi.

The investigators noted that approximately one third of the difference in diabetes prevalence between counties in the diabetes belt and the rest of the nation is associated with low physical activity and obesity. “Culturally appropriate interventions aimed at decreasing obesity and sedentary lifestyle in counties within the diabetes belt should be considered,” they advised.