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Chasing diabetes quality points

Several things stick out when studying the diabetes quality indicators:

nMost of the indicators are time specific – nothing done more than 12 or 15 months before April 1, 2005. So don't worry about past poor results. Rather, concentrate on implementing plans to approach the targets from now on. This is not a sprint but a long-distance run. Like laps in a race, consider setting intermediate goals and then monitoring progress.

nHitting the full blood pressure and glycaemic control targets are worth 50 points – half of the total diabetic points. Prioritise on these and be prepared to treat aggressively. Blood pressure can be measured quickly at some point during most consultations and, not withstanding how much NICE guidance will disagree with British Hypertension Society guidelines, GPs should feel confident in prescribing suitable combinations of BP-lowering agents.

nThe target of 145/85 in 55 per cent of listed diabetics is far from impossible. Glycaemic control is trickier as patient compliance involves rather more than just taking medication. Nevertheless, the HbA1c targets of less than 7.5 per cent in 50 per cent and less than 10.1 per cent in 85 per cent are not totally beyond the realms of possibility. They can be approached, and also achieved, by combining sensible, realistic lifestyle advice (nothing fancy) with more frequent follow-ups (particularly if raised HbA1c) and the readiness to increase the dose of oral agents or convert earlier on to insulin.

nIt means extra work, but there are big points (and bucks) here for the taking. Additionally, lipids are worth up to nine points: never ignore diet, but statins are very effective in lowering total cholesterol. So when a diabetic attends for whatever reason, think BP, HbA1c and cholesterol, then act as necessary.

Steve Levene is a GP in Leicester

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