If you are a Medicare recipient with diabetes and you live in New England, the upper Midwest or the Pacific Northwest, you're more likely to get A1C tests and eye exams than people in other parts of the country. For lipid testing, however, you'd be better off living in the mid-Atlantic states or some Southern coastal states. Those who live in the Ohio Valley, the lower Mississippi Valley or the Southwest are least likely to have their A1C levels measured and eyes examined. Lipid testing was least likely to occur in the Rocky Mountain states and parts of the lower Mississippi Valley.

Those are a few of the anomalies in diabetes care found by researchers who studied Medicare claims data filed between 1997 and 1999 for all 50 states. They used the data to determine rates for three quality-of-care measures: A1C tests, eye examinations and lipid profiles.

Overall, one-third of the 2 million Medicare beneficiaries between the ages of 17 and 75 who have diabetes failed to get annual A1C tests, biennial eye examinations or biennial lipid profiles.

"Different approaches may be needed among and within the states to improve care for each of the quality measures examined," according to the researchers.

—Diabetes Care, December 2002

Clinical adviser's note: It is distressing to see that more than one-third of these Medicare beneficiaries with diabetes did not receive care that matched the quality standards used in this study. But the situation is even worse if we consider the higher standards for quality of care advised by the American Diabetes Association. The ADA recommends checking A1C levels at least twice a year for people who are meeting their goals and are stable, and quarterly if treatment changes or if goals are not being met. Annual dilated eye examinations and annual lipid profiles also are standard, but monitoring lipids can be less frequent if results are normal.