[Five years of DiabCare--France: assessment and outlook]

The Declaration of Saint Vincent was the starting point for the European DiabCare system. Five years of French experience with this system now provide an opportunity for critical assessment. Within the perspective of quality assurance, DiabCare is an efficient developmental tool which should eventually allow the divergence between real and ideal quality to be reduced. On the basis of a European scientific reference system, each country uses its own funds to organise national campaigns with the assistance of pharmaceutical firms. Each year a transverse collection of a month's data concerning all hospitalised diabetic patients is done at the European level by means of a standardised form. Confidential and anonymous analysis of the data is then performed by the scientific committee of DiabCare-France and the CERIM of Lille. Each participating physician receives a report specifying the situation for his group and providing anonymous comparisons with national data. This rich database offers each centre the possibility for "personalised" appraisal and retrospective evaluation of modifications in medical practices. DiabCare is in fact of interest to a variety of persons and organisations. For the patient, the DiabCare sheet and the forthcoming Diabcard (smart card) are means of providing guidance for the annual checkup. The general practitioner or specialist has indications about his patients' condition and guidance for more rigorous management. Interestingly, DiabCare is the only evaluation programme approved by general practitioner unions. For the hospital department, DiabCare provides much more detailed information than PMSI, offering a department head useful arguments in support of specific budget allocations and allowing the care team to consider its activity and determine priorities. It is a useful and precise evaluation tool for hospitals in the perspective of future accreditation. For the national and international scientific community, it provides data which, though biased by voluntary participation and non-epidemiological, are useful for analysis and comparison of particular diabetological circumstances in the field. In this respect, it is noteworthy that the World Health Organisation (WHO), the International Diabetes Federation, and the CSD have supported this initiative. For WHO, care practices and payment systems differ considerably in European countries, so that the existence of a common tool for collecting and evaluating data allows relevant procedures to be identified more quickly and communicated and recommended to the different governments. Finally, in view of the human and economic burden caused by late complications of diabetes, society can benefit. Any improvement in the control of risk factors and the objective reduction of complications is important for survival of the health care system.