Approaches to quality of control in diabetes care

Management methods for quality of diabetes care need new approaches because of the poor metabolic control of most of these patients. Poor quality of care generally results from poor instruction and training rather than from misbehaviour of both patients and their families. Structure quality of care (who and where?), process quality (how?, which are the goals, what resolution is taken and what advice for every-day life is given) and outcome quality (which measurements must be done for the evaluation of the progression of the disease and its control) must all be ameliorated and improved. Regional governments and communities should raise funds for the establishment of diabetes centers, giving recognition and economic support to diabetic children and their families and providing for educational programs on diabetic management and care. The educational aspect seems to be crucial for a good metabolic control not only for the practice of treatment (insulin dosage, home blood glucose monitoring, diet, insulin algorithms), but especially for the active involvement of patients and their families in the management of diabetes. It is also important to consider social and cultural differences among patients in order to arrange therapy according to the individual's characteristics and needs. Improvement of quality of care in diabetic children and adolescents must be pursued; better glycemic control is, in fact, one of the major factors which can contribute to possibly reduce the frequency of macro- and microvascular diabetic complications in the coming years.