The care of a 25% (n = 559) random sample of all patients with diabetes in a district was assessed to determine whether comprehensive diabetes care was being achieved. Process measures initially assessed were repeated 3 years later after several changes in the programme of diabetes care were instituted. The number of patients with diabetes in structured care increased from 91% to 95% between 1991 and 1994, at the same time as an increase in prevalence from 1.2% to 1.8%. There was a shift in the proportion of patients attending primary care from 27% to 40%. There were significant improvements in the delivery of process measures including education. The majority of process measures were delivered to more than 75% of the district diabetes population (for example HbA1c in 93%, fundoscopy in 86%, urine protein in 81%, education on diabetic control in 84%). Comprehensive diabetes care has not yet been fully achieved in North Tyneside district but the programme of care has shown continuous improvement over a 3-year period. Comprehensive diabetes care should be an aim of every district diabetes programme.

This article outlines the development of the District-Wide Diabetes Service which has evolved in North Tyneside over the last decade.We describe how a vision became a reality through team-building, development of an education strategy for team members and agreed protocols of care.The main aims were:To extend a structure of care to all people living in the district who have Type 1 diabetes.To establish and maintain a districtwide register.