PRIMARY HEALTH-CARE OF DIABETIC-PATIENTS IN A SPECIALIZED OUTPATIENT SETTING - A DIABCARE-BASED ANALYSIS

To assure health care quality requires a tool for establishing the fee dback between parameters of patient management and related standards. To assess the current situation and to evaluate the DIABCARE system as a potential monitoring instrument, a retrospective study was performe d in 85 randomly assigned insulin-treated patients (72 % type 2) who w ere regularly attending the diabetes outpatient unit (total of 3 595 p atients) in a township of approximately 90 000 inhabitants. 1 195 reco rds of sequential medical visits during the years 1987 and 1990 were a nalyzed. - Selected results (averages in 1987 vs. 1990) : (1) Visits p er year 6.9 vs. 7.1 ; (2) intensified insulin treatment in 14 vs. 27 % of all patients, they were on 4.0 vs. 4.5 injections per day applying doses of 0.8 vs. 0.6 IU kg-1 d-1; (3) glycaemic control: random blood glucose 6.0 vs. 5.8 mmol/l on conventional and 6.4 vs. 5.7 mmol/l on intensified regimes, HbA1 regular measurements in 2 vs. 21 % of the pa tients; (4) body mass index 26.4 vs. 26.6 (conventional) and 24.7 vs. 25.9 (intensified) kg/(m)2; (5) retinopathy prevalence 30 vs. 29%, in 4 vs. 29 % of the patients no information; (6) nephropathy prevalence 7 vs. 11 %, in 75 vs. 68 % of the patients no information; (7) foot co mplications prevalence 6 vs. 9 %, in 91 vs. 84 % of the patients no pa thological findings. The DIABCARE monitor proved appropriate but too l aborious. The general level of care showed a tendency towards improvem ent between the two investigated periods but did not yet meet the stan dards which must be attained to attain the St. Vincent Declaration.