Differences in treatment regimes, consultation frequency and referral patterns of diabetes mellitus in general practice in five European countries.
BACKGROUND
In many European countries, maturity onset diabetes mellitus (DM) is to a large extent managed in general practice.


OBJECTIVE
Our aim was to compare management of DM in general practice in five European countries in order to contribute to international guidelines on the management of DM by GPs.


METHODS
Routine monitoring of patients presenting with DM was performed during a 12 month period (1999-2000) to GPs in established sentinel practice surveillance networks in five European countries (Belgium, Croatia, England, Spain and The Netherlands). Results were stratified by age and country.


RESULTS
The proportion of patients treated by diet only varied from 13% (The Netherlands) to 25% (Spain); diet and oral antidiabetics from 51% (England) to 62% (Belgium); a combination of diet and insulin varied from 15% (Belgium and Croatia) to 26% (The Netherlands); and a combination of diet, oral antidiabetics and insulin was <10% in all countries. In the older age groups, insulin is prescribed most frequently in The Netherlands. Spain and Croatia show high consultation rates for DM; England and The Netherlands show low rates. Referral percentages vary considerably between countries (highest in Croatia).


CONCLUSIONS
National differences found included the use of insulin in the elderly, the consultation frequency in general practice and the referral rate to ophthalmologist and diabetic specialists. Further quantitative and qualitative studies are needed to explore the needs for support in diabetes management in general practice in Europe.
Donker
Gé A
GA
NIVEL-Netherlands Institute for Health Services Research, Utrecht, The Netherlands. ge.donker@inter.nl.net
Fleming
Douglas M
DM
Schellevis
François G
FG
Spreeuwenberg
Peter
P
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D004704:Endocrinology; D005060:Europe / Q000453:epidemiology; D005194:Family Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use; D008875:Middle Aged; D009885:Ophthalmology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018571:Sentinel Surveillance
D007004:Hypoglycemic Agents; D007328:Insulin