Epidemiologic approaches to the identification of problems in diabetes care.

We conducted two epidemiologic studies in Washington state to identify remediable problems in health care for persons with diabetes. In one study, mortality among persons with diabetes under the age of 45 was found to be 8 times higher than that in nondiabetic individuals of the same age. One-third of the deaths may have been preventable; problems in access to care may have contributed to premature mortality for some of these cases. The second investigation found that in counties with high hospital admission rates for diabetes, medical care may have been suboptimal. In these counties there was greater likelihood of hospitalization for mild metabolic problems, and less vigorous diagnostic and therapeutic management of hospitalized patients with similar case urgency. Population-based epidemiologic studies can identify health care problems and help focus interventions to improve diabetes care.