Changes in prevalence and site of care of diabetes in a health district 1991-2001

Oral health awareness and care preferences in patients with diabetes: a qualitative study

BACKGROUND

People with type 2 diabetes have an increased risk of oral health problems; however, oral health is currently not included in structured diabetes reviews and education in the UK.

AIM AND OBJECTIVES

This study explores the patient's experience related to oral health and diabetes, especially in relation to: • Awareness of the link between oral health and diabetes and oral self-care needs. • Interaction with health professionals in dental and general practice. • Preferences for receiving oral health information and education. Methods This nested qualitative study involved semi-structured telephone interviews with a purposive sample of 20 participants from a questionnaire study on oral health awareness in patients with diabetes. Interview transcripts were analysed using a thematic framework approach.

RESULTS

Participants were mostly unaware of the link between oral health and diabetes. Those that had been made aware by a health professional were not given concrete self-care advice. Interactions with dental professionals were often limited to informing the dental practice of their diagnosis and current medication. Most participants were in favour of dentists screening for diabetes, but as their general practice was the hub for diabetes care, they felt GPs or nurses should provide oral health information and discuss oral health with patients.

CONCLUSIONS

Written information regarding diabetes and its possible effects on oral health needs to be more readily available to people with diabetes, especially at diagnosis. There may be a place for introducing a structured oral health question in routine diabetes reviews.

Evidence of an accelerating increase in prevalence of diagnosed Type 2 diabetes in British men, 1978-2005

BACKGROUND

The prevalence of Type 2 diabetes is increasing worldwide; predictions suggest that the disease will reach epidemic proportions this century. This study aims to estimate the extent of the increase in prevalence of diagnosed Type 2 diabetes in British men between 1978 and 2005.

METHODS

A representative cohort of 7722 British men aged 40-59 years at entry in 1978-1980 were selected from general practices in 24 British towns. Seven sequential questionnaire surveys were carried out between 1978 and 2005, recording recall of a doctor diagnosis of diabetes at each time point. Logistic regression models with generalized estimating equations were fitted to provide age-adjusted estimates of the calendar year increases in odds of Type 2 diabetes, both overall and for consecutive periods, each of approximately 5 years.

RESULTS

The crude prevalence of Type 2 diabetes increased from 1.2% in 1978-1980 to 12.1% in 2005. The age-adjusted average annual increase in Type 2 diabetes prevalence for the 27-year study period was 7.0% [95% confidence interval (CI) 5.4%, 8.6%]. However, the age-adjusted annual rate of increase increased over time, from 4.3% (95% CI 0.4%, 8.2%) between 1979 and 1984 to 11.8% (95% CI 8.4%, 15.4%) between 2003 and 2005; P (trend) = 0.01. The highest annual increases occurred in subjects with higher mean body mass index levels and in towns in Scotland.

CONCLUSIONS

The prevalence of Type 2 diabetes has risen substantially in Britain during the last three decades; the recent rate of increase has been almost three times greater than that in the early 1980s.

Patients' perceptions and experiences of transitions in diabetes care: a longitudinal qualitative study

OBJECTIVE

To examine patients' perceptions and experiences over time of the devolvement of diabetes care/reviews from secondary to primary health-care settings.

DESIGN

Repeat in-depth interviews with 20 patients over 4 years.

PARTICIPANTS AND SETTING

Twenty type 2 diabetes patients recruited from primary- and secondary-care settings across Lothian, Scotland.

RESULTS

Patients' views about their current diabetes care were informed by their previous service contact. The devolvement of diabetes care/reviews to general practice was presented as a 'mixed blessing'. Patients gained reassurance from their perception that receiving practice-based care/reviews signified that their diabetes was well-controlled. However, they also expressed resentment that, by achieving good control, they received what they saw as inferior care and/or less-frequent reviews to others with poorer control. While patients tended to regard GPs as having adequate expertise to conduct their practice-based reviews, they were more ambivalent about nurses taking on this role. Opportunities to receive holistic care in general practice were not always realized due to patients seeing health-care professionals for diabetes management to whom they would not normally present for other health issues.

CONCLUSIONS

It is important to educate patients about their care pathways, and to reassure them that frequency of reviews depends more on clinical need than location of care and that similar care guidelines are followed in hospital clinics and general practice. A patients' history of service contact may need to be taken into account in future studies of service satisfaction.

The effect of screening on the prevalence of diagnosed type 2 diabetes in primary care

OBJECTIVE

To investigate to what extent differences in diagnosed diabetes prevalence can be attributed to differences in the general practitioner's (GP) screening activity.

DESIGN

An analysis of electronic patient files in combination with a survey among GPs. Setting. Ten primary healthcare centres with 44 GPs in the Netherlands.

PATIENTS

General population (n = 58,919) and type 2 diabetic patients (n = 2582).

MAIN OUTCOME MEASURES

Each GP filled in a questionnaire with questions concerning screening methods for diabetes. The presence of diabetes and date of diagnosis were determined. The potential confounding variables age, sex, and postal code (which we used to determine socioeconomic status) were retrieved from patient records.

RESULTS

The yearly point prevalence of diabetes increased significantly from 2.92% in 2000-2001 to 4.25% in 2005-2006 (p = 0.002). The incidence increased from 3.29/1000 person-years to 5.13/1000 person-years (p = 0.019). High screening activity of the general practitioner resulted in statistically significantly higher odds (1.35; p = 0.015) of being diagnosed as a patient with diabetes. The effect was independent of the influence of age, gender, and socioeconomic status.

CONCLUSION

Screening activity of the GP has a statistically significant and relevant influence on the prevalence of diagnosed diabetes. General practitioners should evaluate their screening activity to optimize the identification of diabetic patients.

Structuring diabetes care in general practices: Many improvements, remaining challenges

BACKGROUND

For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way.

AIM

To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care.

METHODS

An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on.

RESULTS

Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population.

CONCLUSIONS

Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.

Diabetes service provision: a qualitative study of newly diagnosed Type 2 diabetes patients' experiences and views

AIMS

To explore newly diagnosed Type 2 diabetes patients' views about Scottish diabetes services at a time when these services are undergoing a major reorganization. To provide recommendations to maximize opportunities brought by the devolvement of services from secondary to primary healthcare settings.

METHODS

Qualitative panel study with 40 patients newly diagnosed with Type 2 diabetes, recruited from hospital clinics and general practices in Lothian, Scotland. Patients were interviewed three times over 1 year. The study was informed by grounded theory, which involves concurrent data collection and analysis.

RESULTS

Patients were generally satisfied with diabetes services irrespective of the types of care received. Most wanted their future care/review to be based in general practice for reasons of convenience and accessibility, although they disliked it when appointments were scheduled for different days. Many said they lacked the knowledge/confidence to know how to manage their diabetes in particular situations, and needed access to healthcare professionals who could answer their questions promptly. Patients expressed a need for primary care professionals who had diabetes expertise, but who had more time and were more accessible than general practitioners. Patients who had encountered practice lead nurses for diabetes spoke particularly positively of these professionals.

CONCLUSIONS

Nurses with diabetes training are particularly well placed to provide information and support to patients in primary care. Ideally, practices should run 'one-stop' diabetes clinics to provide structured care, with easily accessible dietetics, podiatry and retinopathy screening. Newly diagnosed patients may benefit from being made more aware of specific services provided by charitable organizations such as Diabetes UK.

Sustainability and effectiveness of comprehensive diabetes care to a district population

AIMS

To evaluate whether diabetes care in a district population can be sustained over time and intensive management of multiple risk factors can be achieved against a background of rising prevalence of known diabetes and shift of responsibility towards primary care.

METHODS

Assessment of process and outcome measures achieved by a comprehensive diabetes service. Routine data were collected from patients registered with diabetes in a district population by repeated cross-sectional survey in 1991 (n = 2284 patients) and 2001 (n = 5809 patients).

RESULTS

Between 1991 and 2001 the recording of body mass index (76.8 vs. 71.3%, P = 0.01) and HbA(1c) measurement (92.2 vs. 86.4%, P < 0.001) decreased, whereas recording of smoking status (72.4 vs. 82%, P < 0.001), cholesterol level (54.7 vs. 82.5%, P < 0.001) and eye screening result (86.1 vs. 91.3%, P < 0.001) improved. Surviving patients with Type 2 diabetes had significant improvements in systolic blood pressure, diastolic blood pressure and cholesterol, significant deterioration in HbA(1c) and creatinine, and no change in body mass index. Changes in blood pressure and HbA(1c) over time were similar to those reported in the UKPDS.

CONCLUSIONS

The delivery of processes and outcomes of care to a district population can be sustained at a high level over a 10-year period within a comprehensive diabetes service. We would suggest that a multifaceted complex intervention is required to achieve these results.