Medical Expenditure Panel Survey Agency for Healthcare 

Research and Quality

STATISTICAL BRIEF #105 

December 2005 

Highlights 

 In 2003, 6.6 percent of the 

U.S. civilian noninstitutionalized population over 18 

(14.2 million people) 

reported being diabetic. 

 Men and women had 

comparable reported rates 

of diagnosed diabetes (6.6 

percent versus 6.7 percent, 

respectively).

 The reported rate of 

diagnosed diabetes for 

those age 65 and older 

(16.6 percent) was 3.5 

times as likely as the rate 

for those age 18 to 64 (4.7 

percent). 

 Non-Hispanic blacks had 

higher rates of reported 

diagnosed diabetes than 

Hispanics or non-Hispanic 

whites (9.5 percent versus 

6.5 percent and 6.1 

percent, respectively). 

 Adults reported to having 

been diagnosed with 

diabetes were three times 

as likely to have cardiovascular disease or 

stroke as the overall adult 

population. 

Diabetes Management: Tests and 

Treatments among the 18 and Older 

U.S. Civilian Noninstitutionalized 

Population in 2003 

Anita Soni, PhD 

Introduction 

Diabetes mellitus is a group of diseases characterized by high levels 

of blood glucose resulting from defects in insulin production, insulin

action, or both. Diabetes is associated with a number of other health

problems, including heart disease, stroke, high blood pressure, 

kidney disease, and blindness. If diagnosed and treated effectively, 

these complications and co-morbidities could be delayed or treated.

This Statistical Brief uses data from the Household Component of 

the 2003 Medical Expenditure Panel Survey (MEPS-HC) to estimate 

the health status, preventive health practices, and treatment 

regimens of adults who reported having been diagnosed with 

diabetes. Rates at which persons with diabetes obtain preventive 

medical care and recommended tests are presented. 

It should be noted that all references to diabetics in this brief refer to

those reported to have ever been diagnosed with this disease by a 

physician. All comparisons discussed in the text are statistically 

significant at the .05 level unless otherwise noted. 

Findings 

Diabetes can affect many parts of the body and can lead to serious 

complications, such as blindness, kidney damage, and lower-limb 

amputations. Working together, people with diabetes and their health 

care providers can reduce the occurrence of these and other diabetic 

complications by monitoring and controlling the levels of blood 

glucose, blood pressure, and blood lipids. Among several methods 

of monitoring and controlling are the yearly hemoglobin A1c test, 

dilated eye exams, and foot exams for all diabetics. 

Demographics 

In 2003, 6.6 percent of the adult U.S. civilian noninstitutionalized population (14.2 million) was reported to 

be diabetic. Men and women had comparable reported rates of diagnosed diabetes (6.6 percent 

versus 6.7 percent, respectively). 

 
Diabetes was found to be strongly correlated with age. The reported rate of diagnosed diabetes for those 

aged 65 and older (16.6 percent) was 3.5 times as likely as the rate for those aged 18 to 64 (4.7 percent). 

When men and women were compared, even though the percentages were similar for the 18–64 age 

group (30.1 percent of men versus 29.3 percent of women), there were more women who reported having 

diabetes in the 65 and older age group than men (23.1 percent versus17.6 percent) (figure 1). 

With respect to race/ethnicity, non-Hispanic blacks were more likely to have been diagnosed with 

diabetes (9.5 percent) than Hispanics (6.5 percent) and non-Hispanic whites (6.1 percent) (figure 2). 

Management: Diagnostic tests 

In 2003, 41.7 percent of adults with diagnosed diabetes reported having received all three recommended 

tests (hemoglobin A1C, dilated eye exam, and foot exam) (figure 3). However, the majority of the adult 

diabetic population received only one or two of these tests (50.1 percent). There were a small percentage 

of persons (4.6 percent) who did not obtain any of the recommended diagnostic tests. It should be noted 

that 3.6 percent of diabetics did not know whether they had received one or more of these tests for diabetic 

screening. 

Non-Hispanic whites were somewhat more likely than non-Hispanic blacks or Hispanics to report having 

received all three tests (45.4 percent versus 32.0 percent and 35.7 percent, respectively). 

There were significant age-related differences in diagnosed diabetes. Adult diabetics between the ages of 

18 and 64 were much less likely (38.5 percent) to have received all three tests when compared with 

people age 65 and above (46.7 percent). 

Adults between the ages of 18 and 64 with private insurance were much more likely to have received all 

three tests when compared with those of the same age group with public insurance or who were 

uninsured (44.2 percent versus 26.6 percent and 23.5 percent, respectively). 

For persons ages 65 and above, those with Medicare plus private (including TRICARE) insurance were 

more likely to receive all three tests (52.3 percent) when compared with persons with Medicare only 

coverage or persons with Medicare plus other public insurance coverage (45.2 percent and 33.1 percent). 

Management: Treatments 

While diabetes can be controlled by following a careful diet and taking oral medications, in some cases, it 

is necessary to have insulin delivered by injections or a pump. MEPS data indicated that over 80 percent 

(80.7 percent) of adult diabetics used diet modification to help control their diabetes (figure 4). Almost 

three-fourths (73.6 percent) of diabetics were taking oral medications to keep their diabetes in control, 

while only about one-quarter of the population (25.9 percent) was using insulin for treatment of their 

diabetes. A small percentage of diabetics (4.5 percent) did not use any of these three methods to treat 

and/or control their diabetes. 

Complications 

In 2003, 81.1 percent of diabetic adults were overweight/obese compared with 57.7 percent of nondiabetic adults (figure 5). In addition, adult diabetics were more likely than non-diabetic adults to have 

reported a number of other chronic health conditions. Diabetics were three times as likely to have 

hypertension (64.4 percent versus 18.8 percent) and were almost four times as likely as the non-diabetic 

adult population to have had cardiovascular disease or stroke (36.7 percent versus. 9.7 percent). 

Data Source 

The estimates in this Statistical Brief are based upon data from the MEPS 2003 Full-Year Population 

Characteristics data file (HC-073). Specifically, the preventive care and treatment data analyzed in this 

brief were ascertained in a short self-administered questionnaire (the Diabetes Care Supplement), which 

was distributed in Rounds 3/5 of the MEPS to adults identified as having physician-diagnosed diabetes in 

the previous MEPS round. 
Definitions 

Cardiovascular disease and stroke 

The indicator for cardiovascular disease and stroke was drawn from variables indicating presence of 

heart disease (coronary heart disease, angina, heart attack, stroke, or any other heart-related disease). 

For each of the conditions listed, the following question was asked: “(Have/Has) PERSON ever been told 

by a doctor or other health professional that PERSON had [condition].” 

Racial and ethnic classifications 

Classification by race and ethnicity was based on information reported for each family member. 

Respondents were asked if each family member’s race was best described as American Indian, Alaska 

Native, Asian or Pacific Islander, black, white, or other. They also were asked if each family member’s 

main national origin or ancestry was Puerto Rican; Cuban; Mexican, Mexicano, Mexican American, or 

Chicano; other Latin American; or other Spanish. All persons whose main national origin or ancestry was 

reported in one of these Hispanic groups, regardless of racial background, were classified as Hispanic. 

Since the Hispanic grouping can include black Hispanic, white Hispanic, Asian and Pacific Islanders 

Hispanic, and other Hispanic, the race categories of black, white, Asian and Pacific Islanders, and other 

do not include Hispanic. MEPS respondents who reported other single or multiple races and were nonHispanic were included in the other category. 

Health insurance status 

Individuals under age 65 were classified in the following three insurance categories, based on household 

responses to health insurance status questions: 

– Any private health insurance: Individuals who, at any time during the year, had insurance that provides 

coverage for hospital and physician care (other than Medicare, Medicaid, or other public 

hospital/physician coverage) were classified as having private insurance. Coverage by TRICARE 

(Armed Forces–related coverage) was also included as private health insurance. Insurance that 

provides coverage for a single service only, such as dental or vision coverage, was not included. 

– Public coverage only: Individuals were considered to have public coverage only if they met both of the 

following criteria: 1) they were not covered by private insurance at any time during the year, and 2) they 

were covered by one of the following public programs at any point during the year: Medicare, Medicaid, 

or other public hospital/physician coverage. 

– Uninsured: The uninsured were defined as people not covered by private hospital/physician insurance, 

Medicare, TRICARE, Medicaid, or other public hospital/physician programs at any time during the entire 

year or period of eligibility for the survey. 

For individuals 65 and older, the following insurance categories were used: 

– Medicare only: Individuals who, at any time during the year, were covered by Medicare only. For 

analytic purposes, this classification also includes a very small number of persons ages 65 and over 

who did not report Medicare coverage. 

– Medicare plus private (including TRICARE): Individuals who at any time during the year, were covered 

by a combination of Medicare, TRICARE, or private insurance. 

– Medicare plus other public coverage: Individuals who, at any time during the year, were covered by 

Medicare in addition to some other type of public insurance. 

About MEPS-HC 

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health 

care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, 

demographic, and economic characteristics for the civilian noninstitutionalized population. It is 

cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health 

Statistics. 

For more information about MEPS, call the MEPS information coordinator at AHRQ (301-427-1656) or 

visit the MEPS Web site at http://www.meps.ahrq.gov/. 
References 

National Center for Health Statistics, National Vital Statistics Reports: Deaths: Preliminary Data for 2003; 

Vol. 53, No. 15, February 2005. http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_15.pdf

Agency for Healthcare Research and Quality. National Healthcare Quality Report (2004). Rockville, Md.: 

U.S. Department of Health and Human Services. http://www.qualitytools.ahrq.gov/qualityreport/ 

browse/browse.aspx

Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and 

National Estimates On Diabetes in the United States, 2003. Rev ed. Atlanta, Ga.: U.S. Department of 

Health and Human Services, Centers for Disease Control and Prevention, 2004. http://www.cdc.gov/

diabetes/pubs/pdf/ndfs_2003.pdf

For a detailed description of the MEPS survey design, sample design, and methods used to minimize 

sources of nonsampling error, see the following publications: 

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Design Strategies and Innovations in the Medical Expenditure Panel Survey. Medical Care,

July 2003: 41(7) Supplement: III-5–III-12. 

Suggested Citation 

Soni, A. Diabetes Management: Tests and Treatments among the 18 and Older U.S. Civilian 

Noninstitutionalized Population in 2003. Statistical Brief #105. December 2005. Agency for Healthcare 

Research and Quality, Rockville, MD. 

http://meps.ahrq.gov/mepsweb/data_files/publications/st105/stat105.pdf 

∗ ∗ ∗

AHRQ welcomes questions and comments from readers of this publication who are interested in 

obtaining more information about access, cost, use, financing, and quality of health care in the United 

States. We also invite you to tell us how you are using this Statistical Brief and other MEPS data and 

tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. 

Please e-mail us at mepspd@ahrq.gov or send a letter to the address below: 

Steven B. Cohen, PhD, Director 

Center for Financing, Access, and Cost Trends 

Agency for Healthcare Research and Quality 

540 Gaither Road 

Rockville, MD 20850 
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003

Full-Year Population Characteristics file (HC-073)

30.1

17.6

29.3

23.1

0

10

20

30

40

Age 18-64 Age 65+

Men Women

Figure 1. Percentage by age and sex among adults

with reported diagnosed diabetes, 2003

Percent

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003

Full-Year Population Characteristics file (HC-073)

6.5

9.5

6.1

7.6

0

2

4

6

8

10

Hispanic Black nonHispanicWhite nonHispanicOther

Figure 2. Percentage of adults with reported

diagnosed diabetes, by race/ethnicity, 2003

Percent
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003

Full-Year Population Characteristics file (HC-073)

41.7%

3.6%

50.1%

4.6%

All tests No tests 1 or 2 tests Don't know

Figure 3. Percentage of recommended tests 

among adult diabetics, 2003

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003

Full-Year Population Characteristics file (HC-073)

80.7

73.6

25.9

0

15

30

45

60

75

90

Diet Oral medications Insulin

Figure 4. Percentages of adult diabetics using 

various control methods, 2003

Percent
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003

Full-Year Population Characteristics file (HC-073)

Figure 5. Chronic diseases among diabetics, nondiabetics, and all adult U.S. population, 2003

Percent

9.7

81.1

36.7

11.3

58.3

21.5

18.8

57.7

64.4

0

15

30

45

60

75

90

Hypertension Overweight/obese Cardiovascular disease/stroke

All adults Non-diabetic adults Diabetic adults