A Comparison of Diabetes Management in a Federal Prison With the National Standards of Care Published by the ADA in 1998
Uniformed Services University Of The Health Sciences Bethesda United States
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Diabetes Mellitus DM affects 16 million Americans, or 6.2 of the population, and costs the U.S. 120 billion annually. Specifically, within the Federal Bureau of Prisons FBOP, DM affects 5.7 of the total inmate population. It is associated with significant morbidity and mortality. It is the leading cause of blindness, non-traumatic low erextremity amputations, and end-stage renal disease. Results of the Diabetes Control and Complications Trial have shown that intensive treatment can significantly reduce the debilitating and costly long-term complications associated with the disease. Managing achronic illness such as DM can best be accomplished by following nationally recognized standards of care such as those published by the American Diabetes Association ADA. The purpose of this study was to describe the medical management for inmates diagnosed with DM within the FBOP, and compare this to the national standards of care published by the ADA in 1998. To measure adherence to the ADA standards, this descriptive quantitative study utilized the Diabetes Quality Assurance DQA Checklist to perform a chart review in a federal prison outpatient clinic. The DQA Checklist major categories include referrals, blood glucose evaluation, diet and exercise, foot care, cardiovascular risk factors, and laboratory tests. Cardiovascular risk factor assessment, cholesterol and triglyceride measurement, nutrition assessment, opthalmology and ECG referrals were at greater than 87 adherence. However, the degree of adherence was significantly lower in the areas of glycohemoglobin measurement, documented foot exam, HDL and LDL cholesterol measurement.