Measures of disease control in Medicare beneficiaries with diabetes mellitus

OBJECTIVE: To investigate measures of disease control for Medicare benefici aries with diabetes and their outpatient care in the fee-for-service settin g. DESIGN: Retrospective cohort study. SETTINGS: Office practices in Alabama, Iowa,, and Maryland of 293 primary c are physicians (PCPs) who volunteered to participate in the Ambulatory Care Quality Improvement Project. PARTICIPANTS: A total of 5980 patients with an average age of 75.2 years. MEASUREMENTS: For an 18-month period (1/1/94 - 6/30/95), medical records we re abstracted for clinical parameters, including up to four blood glucose v alues; two blood pressure measurements; one total cholesterol value; two se rum creatinine values; medication use, including antihypertensives, angiote nsin- converting enzyme (ACE) inhibitors, and lipid-lowering agents; and fr equency of glycosylated hemoglobin (GHb) determinations. RESULTS: During th e study, 44% of patients received at least one GHb determination, 94% recei ved at least one blood glucose, 68% at least one total serum cholesterol, 7 4% at least one serum creatinine test, and 97% at least one blood pressure measurement. Ten percent of patients had mean blood glucose levels greater than or equal to 250 mg/dL. Eighty-five percent had evidence of hypertensio n. Of this group of hypertensive patients with blood pressure readings avai lable, 70% had blood pressure readings greater than or equal to 140/90 mm H g, even though there were on medication that could have been prescribed for hypertension. Thirty-six percent of those who had evidence of hypertension were taking an ACE inhibitor. Thirty-two percent of those taking lipid-low ering medication had a total serum cholesterol value greater than or equal to 240 mg/dL. Statistically significant differences were noted for age and gender, with men and patients more than 85 years old generally having bette r measures of disease control. CONCLUSIONS: Many older Medicare patients with diabetes did not achieve rec ommended target levels of blood glucose, blood pressure, and lipids. GHb an d serum cholesterol are not being monitored at recommended intervals. Signi ficant opportunities exist to improve diabetes care for this population.