Organisation of diabetes care:
The way diabetes care is organised is very variable between different countries.
Boyages et al (1999) summarised the different organisational approaches to those with chronic diseases, such as diabetes:
1) Shared care, where there is a formalised link between various players in the health care systems, for any given condition
2) Coordinated care, where funding is pooled for purchasing health services for individuals in a defined population
3) Continuum of care, where medical care is provided as a succession of co-ordinated and uninterrupted events
4) Integration of care, where two or more services are linked together by various means to allow treatment of an individual in a co-ordinated and comprehensive manner
Diabetes centres:
These are popular in the UK, Australia and elsewhere for the deliver of multidisciplinary care to the person with diabetes (example of integrated care)
core staff usually consist of a diabetologist, diabetes nurse specialist/eductor, dietician and podiatrist
ready access to other specialities is usually available – nephrologist, vascular surgeon, ophthalmic surgeon, orthopaedic surgeon, cardiologist, psychologist, obstetrician. Footwear technicians and orthotists are also often involved
the function of the diabetes centre are usually to:
diagnosis and the initial assessment of those newly diagnosed
long tern follow up
the education of patients
screening for the chronic complications
high risk foot care
specialist medical care
telephone advice
Annual reviews:
The use of a comprehensive annual review is a key in the delivery of structured diabetes management.
The annual review should consist of :
Discussion:
general state of health
review of results of self monitoring
enquiry about episodes of hypoglycaemia and hyperglycaemia
knowledge about diabetes and aspects of self management
enquiry about tobacco and alcohol use
discussion of other diabetes related problems
Physical examination
• body weight
• waist circumference
• blood pressure measurement
• assessment of visual acuity
• detailed fundus examination
• inspection of feet and footwear
• injection sites
Investigations:
urinalysis
glycated haemoglobin
serum creatinine and electrolyte concentrations
serum lipids
Management:
• glycaemic control – diet, medication, exercise
• assessment of co-existing conditions
• review of ancillary medications
• attention to modifiable cardiovascular risk factors
• management of long term complications
• management plan for next 12 months – eg specialist referrals, pregnancy plans
• arrange review dates
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