Health care delivery in type 2 diabetes. A survey in an Italian primary care practice

Aims: Evidence-based guidelines provide targets and performance measures for the treatment of type 2 diabetic patients but a wide gap separates guidelines-driven recommendations from their clinical application, a phenomenon hindering the transfer of proven benefits to affected populations. Methods: We analyzed the quality of diabetic care delivered by 8 general practitioners joint in a group practice attending 571 diabetic patients (5.6% of the total enlisted subjects) by assessing process (% of HbA(1c), SBP and LDL-C determinations) and intermediate outcome (% of patients with HbA(1c) <7% vs >8%, systolic BP <130 mmHg vs >140 mmHg, LDL-cholesterol <100 mg/dL vs >130 mg/dL) indicators. Results: HbA(1c), was at target in 49% of patients and >8% in 22%; SBP and LDL-C determination was available in about two-thirds of patients, only a minority at target for SBP and LDL-C. Antihyperglycemic and antihypertensive treatment was prescribed in most patients but only a third was on statins. During the post-evaluation phase, percentages of patients with HbA(1c), >8%, SBP <130 mmHg and LDL-C <100 mg/dL and the drug prescription pattern did not change. Conclusions: Several weaknesses affect primary care delivery to type 2 diabetic patients and efforts are needed to improve the management of this high-risk group. (c) 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.