Key health outcomes indicators, one on the incidence of end-stage kidney disease and the other on potentially preventable hospital admissions, suggest notable improvements in the quality of diabetes care in America, according to reports from the Centers for Disease Control and Prevention (CDC) presented here today at the American Diabetes Association's 65th Annual Scientific Sessions.
“The incidence of end-stage kidney disease in people with diabetes decreased by 30 percent in the six years ending in 2002,” reported Nilka Rios Burrows, MT, MPH, epidemiologist, Division of Diabetes Translation, CDC, in a recent interview. “The cause is probably due to a reduction in the prevalence of kidney disease risk factors, such as hypertension and high blood glucose levels, and people getting better care as well as taking better care of themselves, yielding a healthier population of diabetes patients.”
More good news came from Michael M. Engelgau, MD, MS, Associate Director for Prevention Policy in the same CDC division, in the interview. “There was a 35 percent reduction in diabetes-related, potentially preventable hospitalizations from 1994 to 2002.” This study looked at four diabetes-related conditions sensitive to the quality of ambulatory care. “We’ve seen improvements in the quality of diabetes care in the U.S. in recent years, and these trends may be in part reflecting those improvements,” said Dr. Engelgau.
END-STAGE RENAL DISEASE (Kidney Failure)
Diabetes is the leading cause of end-stage renal disease (ESRD) in the U.S. The CDC study found that even though the number of people with diabetes who have ESRD has grown dramatically over the last decade, the age-adjusted incidence of ESRD in diabetes (annual rate of cases) has declined. “Actually, the decline of ESRD really began after an increase that peaked in 1996 at 327 per 100,000 people with diabetes, dropping to 229 in 2002, a 30 percent decrease over six years,” said Ms. Burrows. Incidence varied by age group. It decreased for those younger than 65 years, leveled off for those aged 65-74 years, and increased for people aged 75 years and older. The study used data from the U.S. Renal Data System to obtain the number of people who began treatment (dialysis or kidney transplant) starting in 1990 and had diabetes listed as the primary cause of renal failure. The number of people who initiated treatment rose from 16,634 in 1990 to 42,665 in 2002.
TRENDS IN PREVENTABLE HOSPITALIZATIONS
The study on preventable hospitalizations used as its primary source the Healthcare Cost and Utilization Project National Inpatient Sample from 1994 to 2002, a national sample of about 80 percent of all hospitalizations in the U.S. from 35 states that is weighted to represent the entire country. They looked at four diabetes-related conditions where evidence suggests hospitalization can potentially be avoided through high quality outpatient care – or could be less severe if treated early and appropriately.
The four conditions were: uncontrolled diabetes; short-term diabetes complications such as uncontrolled high blood glucose levels or diabetic ketoacidosis; long-term diabetes complications such as chronic kidney disease; and lower-extremity amputations, which (when not due to trauma) are often a complication of foot ulcers that patients may be unaware of due to diabetic neuropathy (nerve disease).
Among the four ambulatory care sensitive conditions, uncontrolled diabetes saw the largest decline – from 10 to 4 per 1,000 people with diabetes from 1994 to 2002.
UNDERSTANDING THE CAUSES
Beyond improvements in quality of care, Dr. Engelgau cited several other factors that may have contributed to the decrease in hospitalizations, including: the increase in the numbers of people with diabetes, particularly younger people, because they are not as sick a population yet; and changes in hospital admission policies among health care systems seeking to reduce hospitalizations. The CDC officials emphasized that diabetes onset is getting younger and urged people with diabetes to see their doctors regularly