Targets and reality: A comparison of health care indicators in the US (Pittsburgh Epidemiology of Diabetes Complications Study) and Hungary (DiabCareHungary)

OBJECTIVE - In the U.S., both primary care and specialist physicians share in the care of type 1 diabetic patients, often in an informal collaboration . In Hungary, however, type 1 diabetic patients are generally managed in sp ecial centralized diabetes units. These different treatment settings may le ad to different health care practices and outcomes. To determine if this is true, diabetes care indicators and complications were compared across repr esentative study populations from the 2 countries. RESEARCH DESIGN AND METHODS - The Pittsburgh Epidemiology of Diabetes Compl ications Study (EDC) is a prospective cohort of childhood-onset type 1 diab etic patients. DiabCare Hungary, a multicenter cross-sectional study, was d eveloped fur quality control purposes and provides a nationwide data set of diabetic patients. We identified 2 comparable populations (EDC, n = 416; D iabCare, n = 405) in terms of age (greater than or equal to 14 years) and a ge at onset (<17 years). RESULTS - EDC patients were less likely to receive diabetes education (P < 0.0001), see an ophthalmologist (P < 0.0001), be treated by diabetologists (P < 0.0001), or perform self-monitoring of blood glucose (P < 0.0001). The y were more likely to use conservative insulin regimens (i.e., 1-2 injectio ns/day, P < 0.0001) and have a higher glycated hemoglobin (P < 0.0001), Dia bCare patients more often experienced severe hypoglycemia (P < 0.01) and ha d a lower prevalence of proliferative retinopathy (P < 0.0001), legal blind ness (P < 0.05), and albuminuria (greater than or equal to 30 mg/day, P < 0 .01). No significant differences in macrovascular complications were seen, although rates were generally low. CONCLUSIONS - These data suggest that the 2 populations differ by their dia betes care practices, degree of glycemic control, and microvascular complic ation status.