© IDF (Europe) 1999

2 Framework of diabetes care
3 The diabetes consultation
4 Organization of clinical monitoring
5 Monitoring quality of care

TYPE 2 DIABETES - 2 - DELIVERY OF CARE

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2 FRAMEWORK OF DIABETES CARE

2.1 A framework for quality diabetes care

Ensure provision of the following :

• A diabetes team ( professionals ) with up-to-date skills, including :

doctors
diabetes nurse specialists/assistants and educators
nutritionists ( dieticians )
podiatrists ( chiropodists )

• A solid infrastructure

easy access for people with diabetes
protocols for diabetes care
facilities for education ( Patient education ) and foot care ( Foot problems )
information for people with diabetes
structured records
recall system for Annual Review / eye surveillance
access to quality-assured laboratory facilities
database / software for quality monitoring and development
continuing education for professional staff

• A range of services

for regular review ( often 3-monthly )
for Annual Review
for education ( Patient education )
for foot care ( Foot damage )
for eye surveillance
emergency advice line
access to heart, renal, eye, vascular specialists
joint obstetric service ( Pregnancy )

• A system of quality development

feedback from people with diabetes on service performance
regular review of service performance ( Quality monitoring )

( Top of 'Delivery of care' )

TYPE 2 DIABETES - 2 - DELIVERY OF CARE

TYPE 2 DIABETES - 3 - DIABETES CONSULTATION

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3.1 Consultation infrastructure

Make available for consultations the following :

3.2 Consultation process

Include the following :

• Welcome
  • Friendly greeting and early establishment of rapport

• Problems review
• Identification of :
• recent life-events / new symptoms
• new difficulties in self-management of diabetes
• Review of :
• self-monitored results; discussion of their meaning
• dietary behaviours, physical activity, smoking
• diabetes education, skills, and foot care
• blood glucose, lipid and blood pressure therapy and results
• other medical conditions and therapy affecting diabetes
• Management of :
• arterial / foot risk factors identified at Annual Review
• complications and other problems identified at Annual Review
• Analysis and planning
• Agreement on :
• main points covered
• targets for coming months
• changes in therapy
• interval to next consultation
• Recording
• Completion of :
• structured record / patient-held record

( Top of 'Diabetes consultation' )

( Top of 'Diabetes consultation' )

TYPE 2 DIABETES - 3 - DIABETES CONSULTATION

TYPE 2 DIABETES - 4 - CLINICAL MONITORING

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4 ORGANIZATION OF CLINICAL MONITORING

4.1 Schedule for clinical monitoring at different types of visit

Review topics	Initial review	Regular	Annual
	/ referral	review	Review
Background history
Social history / life-style review
Long-term / recent diabetes history
Complications history / symptoms
Other medical history / systems
Family history diabetes / arterial disease
Drug history / current drugs
Current skills / well-being
Diabetes self-management
Self-monitoring skills / results
Vascular risk factors
HbA1c ( glycated haemoglobin )
Lipid profile
Blood pressure
Smoking
*Urine albumin excretion
Examination / complications
General examination
Weight / body mass index
Foot examination
Eye / vision examination
Urine protein
Serum creatinine
*, not required if proteinuria

( Top of 'Clinical Monitoring' )

TYPE 2 DIABETES - 4 - CLINICAL MONITORING

TYPE 2 DIABETES - 5 - QUALITY MONITORING

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5 MONITORING QUALITY OF CARE

5.1 Protocol for quality development and monitoring of performance

( Top of 'Quality Monitoring' )

TYPE 2 DIABETES - 5 - QUALITY MONITORING

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