Health outcomes for diabetes patients returning for three annual general practice checks

Abstract

Aim: To measure changes in the health status of 840 Type 1 and 9998 Type 2 diabetes patients who had completed three free annual diabetes reviews by December 2005.

Method: We evaluated changes in clinical measures and differences in proportions of patients achieving guideline targets between the first and third reviews. Logistic regression analysis examined variables associated with an absolute decrease in HbA1c level of at least 1% from the first to the third review.

Results: The proportion of patients achieving guideline targets for glycaemic control fell from 17.1% to 12.2% for Type 1 diabetes (p=0.004) and from 56.1% to 50.2% for Type 2 diabetes (p<0.001). There were significant improvements in mean albumin:creatinine ratio, total cholesterol, and high density lipoprotein levels in both diabetes cohorts and mean blood pressure and triglyceride levels in Type 2 patients. Adjusted odds of improved glycaemic control were higher for Type 2 diabetics treated with oral medication only (OR=4.27 (95%CI: 3.45-5.14)), insulin only (OR=7.10 [95%CI: 5.58-9.04]), and insulin and oral therapy (OR=10.05 [95%CI: 7.72-13.09]).

Conclusion: The introduction of a structured and systematic general practice review process aimed at improving diabetes care and patient outcomes resulted in significant improvements in mean blood pressure, cholesterol levels, and albumin:creatinine ratio. There was, however, no overall improvement in glycaemic control