Physician office-based diabetes care: comparison to guidelines for care

Over the past decade, we have seen a significant increase in hospitalizations in South Carolina for the major complications of diabetes: myocardial infarcts (+68 percent), amputations (+61 percent), end stage renal disease (+85 percent), diseases of blood vessels (+100 percent), and eye complications (+52 percent). Many of these late stage complications can be prevented or their progression slowed down by early recognition and institution of intensive, well-defined preventive strategies. Independent surveys reviewed above indicate that such preventive practices are not being fully utilized in South Carolina. As one key example, less than 50 percent of people with diabetes receive self-management education. A number of simple and relatively inexpensive laboratory and physical examinations which would trigger preventive and remedial therapy are also performed at less than adequate frequency. The challenge is for all to use these examinations to guide therapy and to continue to monitor and intervene to prevent complications of diabetes. The DSC Board of South Carolina has developed a Ten Year Strategic Plan with nine major goals to improve diabetes care and outcomes in South Carolina. To improve office-based care of diabetes in South Carolina, all health professionals must assume responsibility for closely monitoring each person with diagnosed diabetes and assure that glycemic control is optimized. Early signs of complications must be recognized and interventions to limit their progression utilized. Screening of high-risk individuals to identify the estimated one-third of persons with diabetes who are undiagnosed, targeted education programs to the primary care professionals who deliver the majority of care to individuals with diabetes, implementation of the proven, cost-effective measures that can prevent (postpone) the complications of diabetes, monitoring of the health care delivery system and addressing the potential barriers to adequate care for all persons with diabetes are essential steps to decrease the burden of diabetes for South Carolinians (Table 1).