Diabetics undertreated, says government report
Most Medicare beneficiaries with diabetes do not receive adequate preventive and monitoring services, according to a recent report from the U.S. General Accounting Office (GAO). That means people with diabetes are at elevated risk for developing lower-extremity infections and chronic ulcers.The GAO found that although more than 90% of the fee-for-service Medicare beneficiaries with diabetes visited their physicians at least twice in 1994, only about 40% received an annual eye exam, and only about 20% received the recommended two specialized blood tests per year to monitor diabetes control. The agency’s conclusions were based on a cohort of 168,000 Medicare beneficiaries.
Utilization rates of diabetes monitoring services also are below recommended levels in Medicare HMOs, according to limited data obtained from published research and other sources, the GAO report states.
The reasons for underuse of recommended monitoring services are unclear, but they may relate to patient and physician attitudes and practices, according to the GAO report. Lack of patient knowledge and motivation, and inadequate support systems are cited as potential barriers to patients who require diabetes care. People with diabetes may not fully understand the seriousness of their disease or the need for regular preventive and monitoring services. In addition, the report notes that substantial out-of-pocket costs burden people with diabetes, which may forestall their pursuit of appropriate care.
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