Targets and reality: a comparison of health care indicators in the U.S. (Pittsburgh
Epidemiology of Diabetes Complications Study) and Hungary (DiabCare Hungary)
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 special centralized diabetes units.
These different treatment settings may lead to different health care practices and
outcomes. To determine if this is true, diabetes care indicators and complications
were compared across representative study populations from the 2 countries. RESEARCH
DESIGN AND METHODS: The Pittsburgh Epidemiology of Diabetes Complications Study (EDC)
is a prospective cohort of childhood-onset type 1 diabetic patients. DiabCare Hungary,
a multicenter cross-sectional study, was developed for quality control purposes and
provides a nationwide data set of diabetic patients. We identified 2 comparable populations
(EDC, n = 416; DiabCare, n = 405) in terms of age (> or =14 years) and age 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). They were more likely to use
conservative insulin regimens (i.e., 1-2 injections/day, P<0.0001) and have a higher
glycated hemoglobin (P< 0.0001). DiabCare patients more often experienced severe hypoglycemia
(P<0.01) and had a lower prevalence of proliferative retinopathy (P<0.0001), legal
blindness (P<0.05), and albuminuria (> or =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 diabetes care practices,
degree of glycemic control, and microvascular complication status.