QUALITY OF DIABETES CARE IN 4 COUNTIES IN SWEDEN

In order to obtain a background knowledge for the implementation of th e St. Vincent Declaration (SVD) Action Programme in Sweden a comprehen sive study of diabetes care was performed in four counties covering a population of about one million inhabitants. Questionnaires were sent to 141 caregiveres and 1480 patients at primary heath care centres as well as at hospital units. In addition, a random selection of 600 pati ent records were scrutinized. Diabetes prevalence was 2-3%, but in som e areas where systematic screening programmes had been performed, the prevalence was about 4%. The majority of patients (78%) was more than 50 years of age. Treatment: at primary care centres 50% were taking or al agents and 30% treated by diet alone, while at hospital clinics 66% were taking insulin and an additional 8% taking insulin in combinatio n with oral agents. Routine examinations for the early detection of di abetic complications were performed regularly with regard to body weig ht, blood pressure and proteinuria (macroalbuminuria), but less freque nt with regard to HbA1C, fundoscopy, foot examinations, blood lipids a nd microalbuminuria. A discrepancy was found between caregivers1 state ments as to the frequency of diagnostic investigations and the reality as documented in patient records. Prevalences of complications were f or hypertension 40-50%, heart disease 30-35%, retinopathy (any type) 2 5-30% and proteinuria 20-25%. If the goals of the SVD are to be achiev ed, better basic monitoring instruments, higher staff awareness of the diabetes problems and a more systematic search for diabetic complicat ions are necessary.