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

ObjectivesTo compare diabetes management in adults between England and the United States, particularly focusing on the impact of a universal access health insurance system. DesignAnalysis 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). Main Outcome MeasuresGlycaemic, lipid and blood pressure control and medication use among individuals with previously diagnosed diabetes. ResultsAmong 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. ConclusionsIndividuals in a healthcare system providing universal access have better managed diabetes than those in a market based system once one accounts for insurance.