• Arch G Mainous, Vanessa A Diaz, Sonia Saxena, Richard Baker, Charles J Everett, Richelle J Koopman, and Azeem Majeed.
• Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA. mainouag@musc.edu
• J R Soc Med. 2006 Sep 1; 99 (9): 463-9.

ObjectivesTo compare diabetes management in adults between England and the United States, particularly focusing on the impact of a universal access health insurance system.DesignAnalysis of the nationally-representative surveys Health Survey of England, 2003 (unweighted n =14 057) and the National Health and Nutrition Examination Survey, 2001-2002 (unweighted n =5411).Setting And ParticipantsAdults 20-64 years of age; individuals >65.Main Outcome MeasuresGlycaemic, lipid and blood pressure control and medication use among individuals with previously diagnosed diabetes.ResultsAmong those aged 20-64 the prevalence of diagnosed diabetes was lower in England (2.7%) than in the USA (5.0%). The proportion with diabetes receiving treatment was similar for the two countries. However, the mean HbA1c in England was 7.6%: in the USA it was 7.5% for those with insurance and 8.6% for those without insurance. The proportion of individuals on ACE inhibitors in England was 39%: in USA it was 39% for those with insurance, and 14% for those without.ConclusionsIndividuals in a healthcare system providing universal access have better managed diabetes than those in a market based system once one accounts for insurance.

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