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Charlton Wilson, MD, Susan Gilliland, PhD, MPH, RN, Theresa Cullen, MD, Kelly Moore, MD, Yvette Roubideaux, MD, MPH, Lorraine Valdez, RN, MPA, CDE, William Vanderwagen, MD and Kelly Acton, MD, MPH

Charlton Wilson is with the Phoenix Indian Medical Center, Indian Health Service, Phoenix, Ariz. Susan Gilliland is with the Statistical Consultation and Research Center, Department of Preventive Medicine, University of Southern California, Los Angeles. Theresa Cullen is with the Office of Information Technology, Indian Health Service, Tucson, Ariz. Kelly Moore, Lorraine Valdez, and Kelly Acton are with the Division of Diabetes Treatment and Prevention, Indian Health Service, Albuquerque, NM. Yvette Roubideaux is with the Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson. William Vanderwagen is with the Office of Clinical and Preventive Services, Indian Health Service, Rockville, Md.

Correspondence: Requests for reprints should be addressed to Charlton Wilson, MD, Indian Health Service, Phoenix Indian Medical Center, 4212 N 16th St, Phoenix, AZ 85016 (e-mail: (charlton.wilson{at}ihs.gov).

Objectives. We reviewed changes in blood glucose, blood pressure, and cholesterol levels among American Indians and Alaska Natives between 1995 and 2001 to estimate the quality of diabetes care in the Indian Health Service (IHS) health care delivery system.

Methods. We conducted a cross-sectional analysis of data from the Indian Health Service Diabetes Care and Outcomes Audit.

Results. Adjusted mean Hemoglobin A1c (HbA1c) levels (7.9% vs 8.9%) and mean diastolic blood pressure levels (76 vs 79 mm Hg) were lower in 2001 than in 1995, respectively. A similar pattern was observed for mean total cholesterol (193 vs 208 mg/dL) and triglyceride (235 vs 257 mg/dL) levels in 2001 and 1995, respectively.

Conclusions. We identified changes in intermediate clinical outcomes over the period from 1995 to 2001 that may reflect the global impact of increased resource allocation and improvements in processes on the quality of diabetes care, and we describe the results that may be achieved when community, health program, and congressional initiatives focus on common goals.

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