Preventive Care Practices

Diabetes-related complications can be serious, costly, and deadly. They include heart disease, stroke, kidney disease and kidney failure, blindness, and amputations of the legs and feet. Diabetes-related complications are more likely and more severe among people whose diabetes is not well managed and those who have had diabetes longer.

People with diabetes can better manage their condition and improve their health by following evidence-based preventive care practices recommended by ADA.23 These practices include getting regular A1C tests and annual foot and eye exams, attending diabetes self-management classes (DSMES), and monitoring their blood sugar level every day. Table 3 presents estimates of the percentage of US adults aged 18 years or older with diagnosed diabetes who reported following ADA’s recommended preventive care practices.

Table 3. Percentage of US Adults Aged 18 Years or Older With Diagnosed Diabetes Who Reported Following Recommended Preventive Care Practices, 2016
State or Territory Two or more A1C Tests in the Last Year Foot Exam by Health Professional in the Last Year Ever Attended a Diabetes Self-Management Class Dilated Eye Exam in the Last Year Daily Self-Monitoring of Blood Sugar
Alabama 66.6 60.1 57.1 57.1 67.7
Alaskaa 62.2 76.1 59.0 57.4 68.3
Arizonab 66.8 66.0 49.9 61.5 64.1
Arkansasc NA NA NA NA NA
Californiab 63.9 62.9 64.5 59.7 42.7
Coloradob 63.2 67.9 54.4 61.1 55.6
Connecticutb 74.8 72.8 47.7 64.6 61.1
Delaware 66.7 69.5 55.3 76.1 50.0
District of Columbia 76.3 69.9 58.4 70.0 64.6
Floridab 74.4 52.4 45.2 62.1 62.2
Georgiab 63.5 65.2 52.9 65.6 61.3
Guam 59.2 66.9 43.4 52.5 42.9
Hawaiib 73.4 74.4 58.4 68.6 51.7
Idahoc NA NA NA NA NA
Illinoisb 67.9 74.2 61.4 61.5 70.2
Indianab 73.1 70.6 59.2 49.8 64.2
Iowab 78.7 79.3 65.2 64.1 65.9
Kansasb 71.4 69.6 59.8 64.6 58.7
Kentuckyb 74.5 69.3 50.0 61.2 64.5
Louisiana 56.0 63.3 47.2 55.8 49.6
Mainea 77.3 80.8 59.3 60.6 60.7
Marylandb 75.4 75.7 59.0 61.9 65.9
Massachusetts 66.3 68.5 42.5 62.7 64.8
Michiganb 65.7 71.6 60.0 62.9 64.3
Minnesotab 75.4 81.4 69.1 74.4 64.8
Mississippi 72.2 69.6 42.5 56.3 69.0
Missouric NA NA NA NA NA
Montanab 72.8 82.7 63.1 58.2 41.6
Nebraskab 69.1 66.0 59.5 61.9 59.5
Nevadab 69.6 74.1 74.0 65.3 75.9
New Hampshireb 80.0 86.4 60.2 66.6 58.4
New Jersey 75.4 64.5 38.7 69.1 52.4
New Mexicob 73.6 75.9 48.1 61.2 65.5
New Yorkb 77.3 71.5 34.8 67.0 56.1
North Carolinab 80.2 77.6 62.5 61.6 65.5
North Dakotaa 66.1 82.7 66.8 58.0 68.0
Ohio 71.8 73.2 51.9 62.2 58.1
Oklahoma 74.7 73.9 56.9 63.8 65.0
Oregonc NA NA NA NA NA
Pennsylvaniab 73.3 81.0 50.5 69.0 63.7
Puerto Rico 63.0 35.1 26.8 50.9 65.5
Rhode Islandb 80.3 76.8 56.8 60.7 70.9
South Carolinab 69.2 63.9 54.1 56.5 62.1
South Dakota 74.9 74.7 59.8 64.1 60.9
Tennesseeb 67.2 60.0 48.8 52.6 65.2
Texas 63.8 70.3 59.8 62.2 55.6
Utahb 69.8 71.2 60.4 57.9 60.4
Vermontb 71.6 72.8 45.7 66.7 67.5
US Virgin Islands 63.6 66.2 32.9 34.8 57.4
Virginia 75.6 73.8 57.4 64.1 63.0
Washingtonb 71.4 74.2 63.1 58.7 63.0
West Virginiaa 77.9 70.1 54.6 54.8 71.1
Wisconsin 78.4 83.2 62.7 57.5 60.5
Wyoming 69.7 65.5 55.4 64.8 70.3

Notes: Percentages are age-adjusted to the 2000 US standard population.
Data source: CDC’s United States Diabetes Surveillance System and Behavioral Risk Factor Surveillance System.
a Data for 4 states are from 2014 because 2015 and 2016 data were not available.
b Data for 29 states are from 2015 because 2016 data were not available.
c Data for Arkansas, Idaho, Missouri, and Oregon were not available (NA) for 2014, 2015, or 2016.

Healthy People 2020, which sets national objectives for improving the health of all Americans, monitors progress toward increasing the percentage of people with diagnosed diabetes who follow preventive care practices. Table 4 shows the Healthy People 2020 targets for each practice and the all-states median percentages for each practice during 2011–2016.

Table 4. Healthy People 2020 Targets and All-States Median Percentages of US Adults Aged 18 Years or Older With Diagnosed Diabetes Who Reported Following Recommended Preventive Care Practices, 2011–2016
Year Two or More A1C Tests in the Last Year Foot Exam by Health Professional in the Last Year Ever Attended a Diabetes Self- Management Class Dilated Eye Exam in the Last Year Daily Self- Monitoring of Blood Sugar
Healthy People 2020 Target 72.9 76.7 62.5 58.7 72.5
2011 68.8 70.8 56.3 60.1 64.2
2012 69.1 69.1 55.3 59.7 63.5
2013 67.3 69.2 55.8 59.5 64.1
2014 68.0 68.0 55.3 58.8 63.5
2015 71.4 71.6 54.4 61.6 63.0
2016 69.7 69.5 55.3 62.2 60.9

Notes: Percentages are age-adjusted to the 2000 US standard population. Percentages in bold met or exceeded the Healthy People 2020 target.
Data sources: CDC’s United States Diabetes Surveillance System and Behavioral Risk Factor Surveillance System.

Dilated eye exams were the only recommended practice that consistently met or exceeded the Healthy People 2020 target during 2011–2016. The lowest percentage was for ever attending a diabetes self-management class. DSMES can increase the use of preventive care practices, help improve quality of life for people with diabetes, and reduce health care costs by lowering the risk of complications.24

However, barriers such as not having insurance coverage, having insurance with high co-payments, and living in a rural area can make it hard for some people to participate in DSMES.17 More research may help find new ways to overcome the challenges that prevent people from accessing DSMES services and address gaps in diabetes preventive care.17

Additional Diabetes Resources
Page last reviewed: February 5, 2021