Betere diabetesregulatie door strikt volgen van de standaard 'Diabetes mellitus type II' van het Nederlands Huisartsen Genootschap

Comparison of diabetes regulation by strict or less strict observance of the relevant standard protocol of the Netherlands College of General Practitioners (NHG standard).

Setting

Two general practices in the region ‘Nieuwe Waterweg Noord’, near Rotterdam, the Netherlands.

Design

Cross-sectional comparative descriptive study.

Method

Type II diabetic patients from two general practices were investigated for diabetic symptoms, type of medication, metabolic abnormalities and (risk factors for) complications in relation to their HbA_1c as a measure of mean blood glucose regulation. One GP strictly observed the NHG standard as a protocol, the other GP used it as a guideline.

Results

Metabolic control was significantly better in the ‘strictly observing’ general practice than in the ‘guideline’ practice: HbA_1c 7.3 (SD: 1.7) versus 8.1 (1.5) (P < 0.01). Systolic blood pressure was also significantly lower in the ‘strict’ practice: 141 mmHg (23) versus 155 mmHg (21) (p < 0.01), but mean age was lower and mean duration of diabetes was significantly shorter. The prevalence of macrovascular complications, diabetic retinopathy and nephropathy did not differ significantly in these practices; symptoms of polyneuropathy, however, were found more often in the patients of the ‘strict’ practice (41 versus 20; p < 0.05).

Conclusion

Good metabolic control in patients with type II diabetes mellitus is made possible by strict application of the NHG standard for general practitioners.