Comprehensive Diabetes Care in North Tyneside

Abstract

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.

Use of Read codes in diabetes management in a south London primary care group: implications for establishing disease registers

“…Our study suggests that this method may underestimate the prevalence of diabetes because many patients do not have the C10 Read code or one of its subcodes recorded in their computerised medical record. This conclusion is supported by the substantially higher prevalence of diabetes in our study than the 1.2-1.5% reported in previous studies 17 – 20. However, some of these differences may be because the populations in which these previous studies were conducted had different ethnic and socioeconomic characteristics from those in Battersea.…”

The diabetes audit and research in Tayside Scotland (darts) study: electronic record linkage to create a diabetes register

“…This prevalence is significantly higher than those previously reported 5 7 19 22 23. and may reflect the fact that general practice lists of patients with diabetes are not comprehensive.…”

“…The most popular method of case identification has therefore been to aggregate general practice records of diabetic patients in the community. This strategy has been adopted in several localities; for example, 2236 patients in North Tyneside,5 4313 patients in Middlesborough,6 5200 patients in Sheffield,21 and 2574 patients in Tunbridge Wells,22 yielding prevalences ranging from 1.18% to 1.5%. The combination of general practice records with hospital records is an alternative approach that has been adopted in some districts 7.…”

“…The conventional approach to creating a diabetes register is by aggregating records held by general practices of patients with diabetes5 6 or by integrating general practice registers with lists of patients who attend hospital diabetes clinics 7. An alternative approach is central linkage of records specific for diabetes.…”

Problem of amputations in patients with newly diagnosed diabetes mellitus

“…In our district, 2.1 % of the population are registered as having diabetes, and this prevalence has remained steady since 1992. The local population is mainly Caucasian (96 %), so that the high prevalence rate, which is higher than in many previous UK studies 22,23 cannot be explained by racial factors. Our prevalence, however, is similar to that observed in the recent DARTS study, 24 which used a different means of estimating the prevalence of diabetes in a Caucasian population, and it is likely that the completeness of our diabetes information system, hospital discharge data, surgical procedure codes, district podiatry records and the regional limb fitting centre data make our assessment particularly accurate.…”