APPROACHES TO QUALITY OF CONTROL IN DIABETES CARE

Management methods for quality of diabetes care need new approaches be cause of the poor metabolic control of most of these patients. Poor qu ality of care generally results from poor instruction and training rat her than from misbehaviour of both patients and their families. Struct ure quality of care (who and where?), process quality (how?, which are the goals, what resolution is taken and what advice for every-day lif e is given) and outcome quality (which measurements must be done for t he evaluation of the progression of the disease and its control) must all be ameliorated and improved. Regional governments and communities should raise funds for the establishment of diabetes centers, giving r ecognition and economic support to diabetic children and their familie s and providing for educational programs on diabetic management and ca re. The educational aspect seems to be crucial for a good metabolic co ntrol not only for the practice of treatment (insulin dosage, home blo od glucose monitoring, diet, insulin algorithms), but especially for t he active involvement of patients and their families in the management of diabetes. It is also important to consider social and cultural dif ferences among patients in order to arrange therapy according to the i ndividual's characteristics and needs. Improvement of quality of care in diabetic children and adolescents must be pursued; better glycemic control is, in fact, one of the major factors which can contribute to possibly reduce the frequency of macro- and microvascular diabetic com plications in the coming years.