THE FEEDBACK BETWEEN MONITORING AND IMPROVEMENT OF QUALITY OF DIABETES CARE

The need for permanent, population-wide, improvement in metabolic care of diabetic patients is generally accepted. This paper highlights som e related aspects which must be considered by any health care provider : (1) Monitoring metabolic or other variables in diabetic patients is an essential tool in routine metabolic care, where a ''short feedback' ' between monitored data and medical or behavioral measures is permane ntly established by the patients themselves, the physicians, the nurse s etc. (2) Quality insurance requires the closure of a ''long feedback '' between informations and interventions, such as conditions, tools, methods, used at the different levels of the care system, from the ind ividual patient to a population scale. (3) Appropriate epidemiological studies are required to program and evaluate the effect of any activi ty aimed at insuring and maybe improving the quality of care of diabet ic patients, especially if one considers the time required to reach '' hard end-points'' such as the evaluation of patient mortality or the o utcome of children from diabetic mothers. (4) The knowledge of inciden ce and prevalence rates of diabetes and its complications, and of risk factors may stimulate the political and economical recognition of the importance of the disease by health care officials. (5) In this way, the medical recognition is also stimulated within the professional tea m responsible for the establishment of the ''long feedback'' of qualit y insurance at the level of a given method, of an individual patient o r of a health care unit, and for the actual implementation of generall y accepted knowledge, everywhere in routine care.