Implementation of a structured care programme for diabetes mellitus in a defined population in mid-Sweden

A local programme for diabetes care, based on the Swedish national programme, was introduced in the Köping-Arboga-Kungsör area in mid-Sweden in 1984. Before the programme was implemented, a survey of diabetes care was performed in the area. Two years later, a new survey involving 92% of 1253 diabetes patients in the area was performed to see if the programme was associated with an improved level of care, more optimal treatment and better metabolic control. A significant number of Type 2 patients were referred from hospital outpatient clinics to the primary health care centres. The proportion of patients on diet only increased from 26% to 30% and the average number of daily injections among insulin-treated patients increased. The average number of check-ups by a doctor decreased and the number of check-ups by specially trained nurses increased. Overall, the number of check-ups per year increased from 3.1 to 3.8. The proportion of the patients fulfilling the HbA1c criterion of 'good metabolic control' (< or = 6.0%) increased significantly, as did those fulfilling the fasting blood glucose criterion (< or = 7.0 mmol l-1). Serum cholesterol and serum triglyceride levels increased. Relative weight, blood pressure, smoking habits, and exercise habits were unchanged. In conclusion, the quality of diabetes care was improved after the diabetes care programme was implemented.