JRSM > Volume 99, Number 9 > Pp. 463-469

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

Arch G Mainous, III¹ Vanessa A Diaz² Sonia Saxena⁵ Richard Baker⁷ Charles J Everett³ Richelle J Koopman⁴   Azeem Majeed⁶

¹ Professor, Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
² Assistant Professor, Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
³ Research Associate, Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
⁴ Assistant Professor, Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
⁵ Lecturer, Department of Primary Care and Social Medicine, Imperial College, London
⁶ Professor, Department of Primary Care and Social Medicine, Imperial College, London
⁷ Professor, Department of Health Sciences, University of Leicester, Leicester, UK

Correspondence to: Arch G. Mainous III PhD E-mail: mainouag{at}musc.edu

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 >65.

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 (2.7%) 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.

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