Methods of assessing the quality of diabetes care

To monitor the progress of the improvement of diabetes care several methods are available such as clinical databases, epidemiological studies, and mortality and morbidity statistics. Developments in information technology have made clinical databases such as the DiabCare System a method of high potential because of high generalisability and the potential participation of many clinicians. Epidemiological studies utilize standardized methods to assess disease outcomes and to quantify risk factors. For example, the EURODIAB IDDM Complications Study indicated that life-style factors may have a direct influence on the risk of complications: 21% of 272 patients aged 15-19 years were smokers, rising to above 30% in those aged 20 and above (n = 1,193). This was associated with poor glycemic control in all age groups. Mortality and mortality statistics have the problem of under-ascertainment but they still provide evidence for substantial excess rates in young IDDM subjects with wide regional variations. Thus, for analysing the outcomes of improvements in the quality of care all available information sources have to be utilized, taking care to assess their accuracy and generalisibility.