An audit of non-insulin-dependent diabetics attending a district general hospital diabetic clinic: implications for shared care between hospital and general practice.
An audit of all 466 non-insulin-dependent diabetic patients first diagnosed between 1979 and 1981 at a district general hospital in Fife was carried out. This involved the retrospective examination of their medical records and follow up of the patients to 1989 with particular reference to mortality and the development of complications. Throughout the study period the hospital, which has a total catchment population of about 160,000, operated a policy of encouraging all newly diagnosed diabetics to be referred to hospital for assessment and management. One hundred and eighty-nine diabetics (41%) died during the follow-up period. In both sexes they had an excess mortality, compared with the Scottish population of the same sex and age in 1981, of approximately 20% at 40 years of age. This increased to double or above between the ages of 60 and 70. The principal underlying cause of death was attributed to macrovascular disease, including 70 (37%) certified as ischaemic heart disease, 33 (17%) as cerebrovascular disease and 10 (5%) as other diseases of circulation. Thirty-five (8%) diabetics developed macrovascular and 23 (5%) microvascular complications during follow-up. We conclude that non-insulin-dependent diabetics have a high mortality, principally from macrovascular causes. A simple audit of mortality is suitable for measuring their care. General practitioner diabetic mini-clinics for the follow-up of non-insulin-dependent diabetic patients will have smaller numbers of patients to review compared with the traditional follow-up clinics seen in most district general hospitals. These may allow earlier detection and treatment of hypertension and dyslipidaemia.(ABSTRACT TRUNCATED AT 250 WORDS)
Duncan
C
C
Diabetic Department, Victoria Hospital, Kirkcaldy, Fife.
Chalmers
J
J
Campbell
I W
IW
Jones
I G
IG
D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality* / Q000628:therapy; D005194:Family Practice / Q000639:trends; D005260:Female; D006767:Hospitals, District / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D011320:Primary Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology