Cooperation between general practitioners and diabetologists and clinical audit improve the management of type 2 diabetic patients

A programme was set up in the Essonne (France) between 1994 and 1998 to imp rove the quality of care for Type 2 diabetic patients. A consensus panel of general practitioners and diabetes specialists established guidelines base d on the French St. Vincent recommendations. An audit involving 73 voluntee r general practitioners (out of 965 in the Essonne) then evaluated complian ce with these guidelines. Care and outcome were assessed in 505 (1995) and 604 (1996) Type 2 diabetic patients. The first audit cycle showed that defi ned standards were not met for several criteria and also revealed a lack of standardisation of HbA1c measurements and delayed intervention when blood glucose control was inadequate. Corrective measures were adopted: cooperati ve protocols for foot care, prevention of nephropathy and retinopathy, stan dardisation of HbA1c, and an educational programme at the primary health ca re level. The second audit cycle showed improvement in foot care (+ 33.6 %) , quality (+ 39.9 %), prescription of HbA1c (+ 11.9 %), and control of bloo d pressure (+ 11.9 %) and blood lipids (+ 12.8 %). The proportion of early interventions in case of inadequate glucose control increased significantly (+ 10.5 %). However, some gaps persisted, mainly regarding screening for c omplications, diet counselling and patient education. This study shows that cooperation between genereal practitioners and diabetes specialists is fea sible and effective in the context of a district-wide approach, and that it facilitates the adoption of international guidelines by local physicians. A project has been developed to provide structured diabetes care in general practice and better access to specialist services in order to improve the outcome of Type 2 diabetic patients.