Sustainability and effectiveness of comprehensive diabetes care to a district population


Dr David L. Whitford, Department of General Practice and Family Medicine, Royal College of Surgeons of Ireland, Mercer's Medical Centre, Lower Stephen Street, Dublin 2, Ireland. E-mail:


Aims  To evaluate whether diabetes care in a district population can be sustained over time and intensive management of multiple risk factors can be achieved against a background of rising prevalence of known diabetes and shift of responsibility towards primary care.

Methods  Assessment of process and outcome measures achieved by a comprehensive diabetes service. Routine data were collected from patients registered with diabetes in a district population by repeated cross-sectional survey in 1991 (n = 2284 patients) and 2001 (n = 5809 patients).

Results  Between 1991 and 2001 the recording of body mass index (76.8 vs. 71.3%, P = 0.01) and HbA1c measurement (92.2 vs. 86.4%, P < 0.001) decreased, whereas recording of smoking status (72.4 vs. 82%, P < 0.001), cholesterol level (54.7 vs. 82.5%, P < 0.001) and eye screening result (86.1 vs. 91.3%, P < 0.001) improved. Surviving patients with Type 2 diabetes had significant improvements in systolic blood pressure, diastolic blood pressure and cholesterol, significant deterioration in HbA1c and creatinine, and no change in body mass index. Changes in blood pressure and HbA1c over time were similar to those reported in the UKPDS.

Conclusions  The delivery of processes and outcomes of care to a district population can be sustained at a high level over a 10-year period within a comprehensive diabetes service. We would suggest that a multifaceted complex intervention is required to achieve these results.