Zorg voor patiënten met diabetes mellitus type 2 in de 1e lijn
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Stand van zaken
03-11-2008
G.E.H.M. Rutten

Care of patients with type 2 diabetes mellitus in primary care

- Over the past 20 years, delivery of diabetes care in the Netherlands has shifted from secondary to primary care. Currently over 75 of all patients with type 2 diabetes mellitus are being treated by a diabetes team in general practice.

- Since 2000 both national and international publications have been describing the organisation and quality of primary diabetes care in the Netherlands.

- Apart from 4 large-scale diabetes projects in the areas of Zwolle, Hoorn, Maastricht and Breda, primary diabetes care is organised in various ways.

- At the end of 2005 a questionnaire sent to a representative group of 1621 general practitioners revealed that 95 kept a computerised diabetes register, one out of three practices delegated tasks to a diabetes service, and 20 of the practices had a shared care protocol with specialists.

- 2 out of 3 practices ran a diabetes clinic in which 2 out of 3 a practice nurse was involved.

- The results of 9 projects are known. 3 projects concern cross-sectional findings of disease management organisations, 6 concern general practices which were not participating in a diabetes project at the time of measurement, and 2 are clinical trials.

- Most of these measurements yielded representative data. They show that mean HbA1c levels < 7, mean systolic blood pressure of about 143 mmHg, and mean cholesterol levels of about 4.5 mmol/l are achievable.

- With logistic support, regular check-ups of fundus and feet are achieved in 9 out of 10 patients. No special organisational model has proved to be superior.

- A correct assessment of quality of care indicators should take into account the heterogeneity of type 2 diabetes mellitus, as well as the socio-economic status and the ethnicity of the patient population.

Ned Tijdschr Geneeskd. 2008;152:2389-94