An audit of structured diabetes care in a rural general practice.
OBJECTIVE
To assess the impact of structured diabetes care in a rural general practice.


METHODS
A cohort study of structured diabetes care (care plans, multidisciplinary involvement and regular patient recall) in a large general practice in a medium-sized Australian rural town. Medical care followed each doctor's usual practice.


METHODS
The first 404 consecutive patients with type 2 diabetes who consented to take part in the program were evaluated 24 months after enrolment in July 2002 to December 2003.


METHODS
Change in cardiovascular disease risk factors (waist circumference, body mass index, serum lipid levels, blood pressure); change in indicators of risks associated with poorly controlled diabetes (glycated haemoglobin [HbA1c] concentration, foot lesions, clinically significant hypoglycaemia); change in 5-year cardiovascular disease risk.


RESULTS
Women had a lower 5-year risk of a cardiovascular event at enrolment than men. Structured care was associated with statistically significant reductions in mean cardiovascular disease risk factors (waist circumference, - 2.6 cm; blood pressure [systolic, - 3 mmHg; diastolic - 7 mmHg]; and serum lipid levels [total cholesterol, - 0.5 mmol/L; HDL cholesterol, 0.02 mmol/L; LDL cholesterol, - 0.4 mmol/L; triglycerides, - 0.3 mmol/L]); and improvements in indicators of diabetic control (proportion with severe hypoglycaemic events, - 2.2%; proportion with foot lesions, - 14%). The greatest improvements in risk factors occurred in patients with the highest calculated cardiovascular risk. There was a statistically significant increase in the proportion of patients with "ideal" blood pressure (systolic, < 130 mmHg; diastolic, < 80 mmHg) and LDL cholesterol level (< 2.5 mmol/L) of 6.4% and 20.5%, respectively.


CONCLUSIONS
Implementing structured care in this rural general practice coincided with improved risk factor management, and may have contributed to the improvement. The greatest benefits were in patients with high cardiovascular risk.
Ackermann
Evan W
EW
Condamine Medical Centre, Warwick, QLD, Australia. g.mitchell@uq.edu.au.
Mitchell
Geoffrey K
GK
D000328:Adult; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology*; D002784:Cholesterol / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000379:methods*; D008875:Middle Aged; D011793:Queensland; D012189:Retrospective Studies; D012307:Risk Factors; D019035:Rural Health Services / Q000706:statistics & numerical data*
D002784:Cholesterol