Purpose:  Since 1997 diabetes practice guidelines have called for lower risk factor targets, intensified medication regimens, and more frequent laboratory tests than in previous guidelines.  We assess recent trends in test ordering for diabetes patients enrolled in a large managed care organization.     

   Method:  We utilized claims data for patients enrolled in health plans affiliated with UnitedHealthCare (UCHP) for the period 1996 to 2000.  We identified non-pregnant adults with diabetes using the HEDIS and Hebert criteria.  Separate cohorts of patients entering the health plan in each calendar year were followed for a period of one year. We studied trends in the 1) proportion of patients receiving a test in their first year, 2) the number of tests ordered in the first year, and 3) the time interval between ordered tests for glycosylated hemoglobin (HbA_1C), urine microalbumin, and serum cholesterol (both lipid panels or specific components of the cholesterol) tests. We compared trends for 31 participating UCHP care plans.

   Results:  We found a steady and progressive rise in the proportion of patients receiving HbA_1C or microalbumin tests over the years (Table 1).  However, the overall proportion of patients receiving the microalbumin test remained low.  A less prominent rise was observed for cholesterol testing. 

	1996	1997	1998	1999	2000
N	11040	19680	28432	28122	38441
HbA1C (%)	28	36	38	43	46
Urine Microalbumin (%)	2	3	4	6	8
Cholesterol test of any kind (%)	38	46	46	48	47

Among patients who received a test, the average annual frequency of HbA_1C (1.9), urine microalbumin (1.2), and cholesterol (1.8) testing did not change significantly.  The median time between the first and second tests also did not change significantly.  These findings were consistent across HMOs.

   Conclusions:  In this national sample of managed care patients, the proportion of diabetes patients receiving the recommended laboratory tests increased significantly, especially for glycosylated hemoglobin.  However, only 50% of patients received a blood glucose or serum cholesterol test when all patients with diabetes should be receiving these tests on an annual basis.  Diabetes care appears to be slowly intensifying as recommended in practice guidelines but significant care improvement is still necessary.