Logistic support service improves processes and outcomes of diabetes care in general practice

Background. Guidelines for type 2 diabetes care in general practice are well known and accepted, but the implementation falls short. Objective. To implement these guidelines by introducing a diabetes support service (DSS) to support the care delivered by the GP. Methods. A controlled, non-randomised study with delayed intervention in the control group; 78 GPs (n = 51 for the intervention and n = 21 for the control group) in the south of the Netherlands and 613 of their type 2 diabetic patients participated. Data were collected on the frequency, content and results of the check-ups (fasting blood glucose, HbA1c, cholesterol, cholesterol/HDL ratio, triglycerides, creatinine, blood pressure, fundus photography, foot examination, body mass index and smoking status) for 3 years. The year before signing up with the DSS was taken for the pre-measurements and after 2 years of DSS the post-measurements took place. The effect of the DSS was analysed in a mixed model with repeated measurement covariance structure. Results. At baseline the intervention and control group did not differ in control frequency and outcome (HbA1c). After the intervention the percentage of patients that attended four or more quarterly check-ups (with at least testing of fasting blood glucose or HbA1c) increased from 59 to 78%. In contrast, the frequency of check-ups in the control group remained constant. This effect was significant. The HbA1c remained the same in the intervention group while there was a significant deterioration in the HbA1c in the control group. Conclusion. Simple logistic support by the DSS proved to have the capacity to implement type 2 diabetes guidelines in general practice.