Diabetes to the year 2000 and beyond. National Action Plan

Patient psychological and information needs when the diagnosis is diabetes

People receiving a diabetes diagnosis must absorb information, change habits and adopt new behaviours almost immediately. Guidelines thoroughly cover the medical aspects of initial management however the information and psychological needs of patients are not addressed. This study aimed to identify diabetes patient needs for information and emotional support at the time of diagnosis. A sample of 1159 patients completed a questionnaire which assessed their concerns and information preferences at the time of diagnosis (response rate 64.4%). A sample of 100 general practitioners (GPs) were interviewed about their perceptions of these issues using a subset of items from the patient questionnaire. The diagnosis of diabetes was distressing for 60% of responders and 23% wanted more emotional support. Immediate issues such as injections were major concerns for patients and GPs correctly identified these. However GPs significantly overestimated complications as a concern for patients at diagnosis. Patients preferred diabetes educators and courses as sources of information. Satisfaction with information at diagnosis was high (80%), however younger patients were dissatisfied with their discussions concerning diabetes therapy. The findings suggest that clinicians giving a diagnosis of diabetes should: (1) be aware of patient variability in needs for emotional support and information preferences, (2) ask patients for their preferences and offer choices if available and (3) provide more information about treatment and increase patient involvement in discussions about therapy.

Management of type 2 diabetes in Western Australian metropolitan general practice

The purpose of this study was: (1) to record GP opinions, practices and outcomes for the care of Type 2 Diabetes Mellitus (DM2), (2) compare practice facilities and process of care with a criterion of recommended competent care and (3) determine if there were any differences between vocationally registered and non-vocationally registered GPs. A random sample of 204 metropolitan doctors from 124 practices was selected and an audit performed on 467 of their patient records. GPs pursued good blood sugar control and advocated lifestyle changes before hypoglycaemic drugs. Over 80% regard uncomplicated DM2 as a condition for general practice management. However, only 15% conducted an annual diabetes check, 9% had a diabetic register, 6% a diabetic recall system and 8% used a diabetic health care checklist for monitoring their patients. The most commonly recorded processes of medical audit in the previous 12 months were: blood pressure (94%), duration of diabetes (72%), blood glucose (70%), diet (66%), body weight (56%), HBA1c (52%) and ophthalmoscopy (50%). The least commonly recorded processes of care were body mass index (5%), inspection of the feet (18%), enquiries about vaginitis or impotence (23%). The amount of exercise, alcohol and tobacco was recorded in only 34% of records. Hypoglycaemic drugs were used appropriately but the most commonly used drugs for treating hypertension in DM2 patients were thiazide diuretics and beta-blockers. Vocationally registered (VR) doctors had better records, higher process of care scores and more were willing to participate in the study than non-vocationally registered (NVR) doctors. However, there was no difference in metabolic control between patients from either group. The use of a Diabetic Health Care Checklist would improve diabetes care especially in the search for early complications and in the recording of HBA1c and other metabolic parameters. The drugs commonly used to control hypertension can have adverse effects on glucose and lipid metabolism and should be replaced with glucose and lipid neutral drugs.