Diabetic patients in primary health care - quality of care three years apart

OBJECTIVE: To compare registering of diabetic complications and metabolic control in diabetic subjects in primary health care in 1992 and 1995. DESIGN: Cross-sectional surveys of medical records. SETTING: Three community health centres in Stockholm County. SUBJECTS: Diabetic patients aged 18-84 years in 1992 (n = 177) and in 1995 (n = 413). MAIN OUTCOME MEASURES: Rate of noted diabetic complications and metabolic values. RESULTS: Retinopathy examination was noted in 64% in 1992 versus 65% in 1995, neuropathy examination in 44 versus 49%, and urine examination in 88% versus 73% (p < 0.001). HbA1c was examined in 52% in 1992 versus 68% (p < 0.001) in 1995, fasting blood glucose in 89 versus 90%, and cholesterol in 34 versus 42%. Acceptable HbA1c values were noted in 51% in 1992 versus 46% in 1995. Smoking habits were available in 26% in 1992 versus 53% in 1995 (p < 0.001) and BMI in 5 versus 39% (p < 0.001). Diabetic blindness was present in 2.2% in 1995, uraemia in 0.3%, and amputation due to gangrene in 1.2%. CONCLUSION: Documented examination rates of diabetic patients are unacceptably low, and the metabolic level unsatisfactory in most cases. Severe complications are, however, rare.