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Item #5
Intensive
Treatment at Onset of Diagnosis of Diabetes Improves Quality of
Care
Primary
care providers do not appear to manage diabetes
diagnosed at screening as intensively as long-standing diabetes.
Screening
for diabetes has the potential to be an effective
intervention, especially if patients have intensive treatment
of their newly diagnosed diabetes and comorbid hypertension. We
wished to determine the process and quality of diabetes care for
patients diagnosed with diabetes by systematic screening.
A
total of 1,253 users of the Durham Veterans Affairs
Medical Center aged 45–64 years who did not report
having diabetes were screened for diabetes with an HbA1c
test. All subjects with an HbA1c level
 6.0%
were invited for follow-up blood pressure and fasting
plasma glucose (FPG) measurements. A case of
unrecognized diabetes was defined as HbA1c
7.0%
or FPG
126
mg/dl. For each of the 56 patients for whom we made a
new diagnosis of diabetes, we notified the patient’s
primary care provider of this diagnosis. One year after
diagnosis, we reviewed these patients’ medical records
for traditional diabetes performance measures as well as
blood pressure. Follow-up blood pressure was also ascertained
from medical record review for all subjects with HbA1c
6.0%
who did not have diabetes. We compared blood pressure
changes between patients with and without diabetes.
The
results showed that among patients diagnosed with diabetes at
screening, 34 of 53 (64%) had evidence of diet or
medical treatment for their diabetes, 42 of 53 (79%)
had HbA1c measured within the year after
diagnosis, 32 of 53 (60%) had cholesterol measured, 25
of 53 (47%) received foot examinations, 29 of 53 (55%) had eye
examinations performed by an eye specialist, and 16 of 53 (30%)
had any measure of urine protein. The mean blood pressure decline
over the year after diagnosis for patients with diabetes was
2.3 mmHg; this decline was similar to that found for 183 patients
in the study without diabetes (change in blood pressure, -3.6
mmHg). At baseline, 48% of patients with diabetes had blood pressure
<140/90, compared with 40% of patients without diabetes; 1
year later, the same 48% of patients with diabetes had blood pressure
<140/90, compared with 56% of patients without diabetes (P
= 0.31 for comparing the change in percent in control between
groups).
In
Conclusion, patients with diabetes diagnosed at screening achieve
less tight blood pressure control than similar patients without
diabetes. Primary care providers do not appear to manage diabetes
diagnosed at screening as intensively as long-standing diabetes
and do not improve the management of hypertension given the
new diagnosis of diabetes. Diabetes Care Feb 2003
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