Impacts and outcomes of diabetes care in a high risk remote Indigenous community over time: implications for practice

The aim of this study was to determine diabetes care processes and intermediate clinical outcomes in a remote primary care service in 2009 compared with 2004. A retrospective review of diabetes care from January 2009 to January 2010 was conducted using a chronic disease register (Project Ferret). Completeness of ascertainment was verified by a manual audit of charts. The results from this audit were compared with a similar study conducted in this community in 2004. The main outcome measure was diabetic management: in terms of (a) regular monitoring of diabetic care processes, and (b) compliance with national optimal management guidelines and comparison with diabetic outcomes data from a 2004 audit and the National data from 2009. People with diabetes on the register increased from 60 in 2004 to 77 in 2009. They were younger and heavier with a shorter duration of diagnosed diabetes. Recording of diabetic care processes in 2009 decreased between 5 and 32% compared with 2004 data. Intermediate clinical measures (e.g. glycosylated haemoglobin, blood pressure, triglycerides, albumin creatinine ratio) indicate stable or poorer diabetic control across all measures except total cholesterol. When compared with non-Indigenous diabetics, diabetes is diagnosed earlier and rates of smoking, hypertension, dyslipidaemia and diabetic nephropathy are higher in this population. Insulin use appears to be lower in the study population than reported in the national sample. Improved diabetic care processes and outcomes reported from 1999 to 2003 have not been sustained, and intermediate clinical measures have become more adverse over a 5 year period in this high risk remote community. Chronic care systems, including quality improvement, require renewed investment.