The current system, rests on a precarious and complex (or should I say, chaotic?) relationship between public and private healthcare providers and the insurance industry. Sadly, reform may not be possible until Americans get much, much angrier about how badly they are being let down by the system that's supposed to serve them. A great place to start your reading is the editorial in today's New York Times. Titled "World's Best Medical Care?," it neatly summarizes not just how the US needs to do better, but also describes how badly the US is doing in relation to the rest of the developed world. The key issues: forty-five million uninsured, many more underinsured, and quality of care that varies wildly depending on the size of the patient's wallet.

What about diabetes? Surprise! The news is not good. According to the Times editorial, the US came in last in an eight-country comparison of lives lost to a number of major diseases, one of which being diabetes.

You may have heard that diabetics face a greater risk of complications during hospital stays. Well, now there's evidence that diabetics with trauma injuries are particularly at risk. That info comes courtesy of a large Pennsylvania study that looked at records for around 25,000 trauma patients, half with diabetes, the other half without. The study tracked the patients' progress over the course of almost twenty years. Impressive.

What did they find? Twenty-three percent of the diabetic trauma patients experienced complications. That compares with only fourteen percent of non-diabetics. The diabetics also spent slightly more time in intensive care and were more likely to need ventilator support. The overall risk of infections was higher too - eleven percent versus six percent.

Good news: despite all this, the data did not suggest people with diabetes are more likely to die after a trauma injury. Nor did it suggest diabetics stay in hospital longer than non-diabetics. The team that conducted the study states that the next step would be to examine whether or not improved blood sugar control in diabetic trauma patients would impact these figures.

Read more about these findings by visiting MedPageToday or, for a brief summary, the Atlanta Journal-Constitution. Or check out the full report, published in Archives of Surgery (July, 2007).

This is most definitely not what you want to hear about the medical experts charged with managing your diabetes: According to those who have been studying the issue, US doctors show a surprising lack of knowledge about diabetes and are not doing enough to manage the disease.

The survey that came up with this conclusion also found that many patients are similarly ignorant about the condition and what they should or should not be doing to control it. In addition, even when patients are armed with correct information, they frequently fail to take the necessary steps to control their diabetes. However, the way I see it, the shortcomings of doctors is the big problem here, as patients are looking to their physicians for guidance, not the other way around!

Now, what to do to improve the situation? The researchers say a team approach would be more productive. They suggest that physicians try a collaborative approach, working with patients, nurses, educators and pharmacists. I hate to be cynical here, but I just don't see that happening with the health system being the way it is now in the US. I would love to know how collaborative health care in diabetes could be achieved. In the meantime, how many people are missing out on optimal care?