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

Objectives To compare diabetes management in adults between England and the United States, particularly focusing on the impact of a universal access health insurance system.Design Analysis 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).Setting and Participants Adults 20–64 years of age; individuals >65.Main Outcome Measures Glycaemic, lipid and blood pressure control and medication use among individuals with previously diagnosed diabetes.Results Among 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.Conclusions Individuals in a healthcare system providing universal access have better managed diabetes than those in a market based system once one accounts for insurance.