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Introduction: Building integrated services in a primary care setting is considered an essential important strategy for establishing a highquality and affordable health care system. The theoretical foundations of such integrated service models are described by the Rainbow Model of Integrated Care, which distinguishes six integration dimensions (clinical, professional, organisational, system, functional and normative integration). The aim of the present study is to refine the Rainbow Model of Integrated Care by developing a taxonomy that specifies the underlying key features of the six dimensions.

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OBJECTIVE -To investigate whether screening-detected diabetic patients differ from diabetic patients newly diagnosed in general practice with regard to the presence of microvascular complications.RESEARCH AND DESIGN METHODS -Diabetic patients, identified by a population-based targeted screening procedure consisting of a screening questionnaire and a fasting capillary whole-blood glucose measurement followed by diagnostic testing, were compared with patients newly diagnosed with diabetes in general practice. Retinopathy was assessed with fundus photography, impaired foot sensitivity was assessed with Semmes-Weinstein monofilaments, and the presence of microalbuminuria was measured by means of the albumin-tocreatinine ratio (ACR).RESULTS -A total of 195 screening-detected type 2 diabetic patients and 60 patients newly diagnosed in general practice participated in the medical examination. The prevalence of retinopathy was higher in screening-detected type 2 diabetic patients than in patients newly diagnosed in general practice, but not significantly higher. The prevalence of retinopathy was 7.6% (95% CI 4.6 -12.4) in screening-detected type 2 diabetic patients and 1.9% (0.3-9.8) in patients newly diagnosed in general practice. The prevalence of impaired foot sensitivity was similar in both groups, 48.1% (40.9 -55.3) and 48.3% (36.2-60.7), respectively. The ACR was 0.61 (interquartile range 0.41-1.50) in screening-detected type 2 diabetic patients and 0.99 (0.53-2.49) in patients newly diagnosed in general practice. The difference in prevalence of microalbuminuria was not statistically significant. The prevalence of microalbuminuria was 17.2% (95% CI 12.5-23.2) and 26.7% (17.1-39.0) in screening-detected type 2 diabetic patients and patients newly diagnosed in general practice, respectively. CONCLUSIONS -Targeted screening for type 2 diabetes (with a screening questionnaire as a first step) resulted in the identification of previously undiagnosed diabetic patients with a considerable prevalence of microvascular complications. Diabetes Care 26:2604 -2608, 2003T ype 2 diabetes is a common and serious disease with chronic complications, and it constitutes a substantial burden for both the patient and the health care system. Type 2 diabetes is characterized by an asymptomatic phase between the actual onset of diabetic hyperglycemia and clinical diagnosis. This phase has been estimated to last at least 4 -7 years, and consequently 30 -50% of type 2 diabetic patients remain undiagnosed (1). Untreated hyperglycemia is an explanation for the relatively high prevalence of retinopathy in newly diagnosed diabetic patients (1,2). Patients in clinical practice are predominantly diagnosed because they have symptoms of hyperglycemia, but screening for type 2 diabetes might make it possible to identify diabetic patients much earlier in the asymptomatic phase. The assumption that early detection and early treatment may prevent or delay the progression of diabetes and its complications has given rise to the recommendations to screen ...

OBJECTIVE -Lower-extremity amputation is a common complication among patients with diabetes throughout the world. However, few data exist on the actual impact of the recent moves to improve the management of diabetic foot ulcers to reduce the incidence of lower-extremity amputations. The aim was to determine the incidence of lower-extremity amputations among diabetic patients from 1991 to 2000 in the Netherlands. RESEARCH DESIGN AND METHODS-A secondary database containing information regarding all hospital admissions in which a lower-extremity amputation occurred for the years 1991-2000 was obtained from the Dutch National Medical Register. Because a patientunique identifier was included, multiple amputations and hospitalizations for a single individual could be identified. Furthermore, age-and sex-specific diabetes prevalence rates were calculated using a 3-year average for every year, calculating the total diabetic population in the Netherlands at risk for every year.RESULTS -In 1991, a total of 1,687 patients with diabetes had been admitted 1,865 times for 2,409 amputations. In 2000, a total of 1,673 patients with diabetes were admitted 1,932 times for 2,448 amputations. The overall incidence rates of the number of patients who underwent lower-extremity amputation decreased over the years from 55.0 to 36.3 per 10,000 patients with diabetes (P Ͻ 0.05). Both in men (71.8 vs. 46.1, P Ͻ 0.05) and women (45.0 vs. 28.0, P Ͻ 0.05) with diabetes, a significant decrease could be observed. Mean duration of hospitalization decreased from 45.0 days (SD 44.4) in 1991 to 36.2 days (SD 38.4) in 2000; decreases were observed for both men and women.CONCLUSIONS -Over the years observed in this study, the incidence rates of diabetesrelated lower-extremity amputation in the Netherlands was found to decrease in both men (36%) and women (38%) with diabetes. Furthermore, the duration of hospitalization decreased over time.