Are the U.S. territories lagging behind in diabetes care practices?

Prim Care Diabetes. 2018 Oct;12(5):432-437. doi: 10.1016/j.pcd.2018.04.005. Epub 2018 May 9.


Aims: Although U.S. territories fall within the mandate outlined by Healthy People 2020, they remain neglected in diabetes care research. We compared the prevalence and secular trends of four recommended diabetes care practices in the U.S. territories of Guam, Puerto Rico, and the U.S. Virgin Islands to the 50 United States and D.C. ("U.S. States") in 2001-2015.

Methods: Data were from 390,268 adult participants with self-reported physician diagnosed diabetes in the Behavioral Risk Factor Surveillance System. Diabetes care practices included biannual HbA1c tests, attendance of diabetes education classes, daily self-monitoring of blood glucose, and receipt of annual foot examination. Practices were compared by U.S. territory and between territories and U.S. states. Multivariable models accounted for age, sex, education, and year.

Results: Of adults with diagnosed diabetes, 7% to 11% in the U.S. territories engaged in all four recommended diabetes care practices compared with 25% for those, on average, in U.S. states. Relative to the U.S. states, on average, the proportion achieving biannual HbA1c testing was lower in Guam and the U.S. Virgin Islands (45.6% and 44.9% vs. 62.2%), while annual foot examinations were lower in Puerto Rico (45.9% vs 66.1% in the U.S. states). Diabetes education and daily glucose self-monitoring were lower in all three territories.

Conclusions: U.S. territories lag behind U.S. states in diabetes care practices. Policies aimed at improving diabetes care practices are needed in the U.S. territories to achieve Healthy People 2020 goals and attain parity with U.S. states.

Keywords: Diabetes; Epidemiology; Healthy People 2020; U.S. territories or disparities.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomarkers / blood
  • Blood Glucose / metabolism
  • Blood Glucose Self-Monitoring / trends
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / therapy*
  • Diabetic Foot / diagnosis
  • Diabetic Foot / epidemiology
  • Female
  • Glycated Hemoglobin A / metabolism
  • Guam / epidemiology
  • Healthcare Disparities / trends*
  • Healthy People Programs / trends*
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance*
  • Patient Education as Topic / trends
  • Physical Examination / trends
  • Podiatry / trends
  • Practice Patterns, Physicians' / trends*
  • Puerto Rico / epidemiology
  • Self Care / trends
  • United States / epidemiology
  • United States Virgin Islands / epidemiology


  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human