Diabetes mellitus is one of the common endocrine diseases affecting all age groups with over one million people in the United Kingdom (UK) having the condition. Effective control and monitoring can reduce mortality and morbidity. Much of the management and monitoring of diabetic patients, particularly patients with Type 2 diabetes is undertaken by the general practitioner and members of the primary care team. This measure is one of sixteen Diabetes Mellitus measures.
The Diabetes Mellitus indicators are based on widely recognised approaches to the care of diabetes. Detailed guidelines for health professionals are published by Diabetes UK and by SIGN - the Scottish Intercollegiate Guidelines Network. The SIGN website contains detailed evidence tables, and links to published articles. The English National Service Framework for Diabetes also includes details of the evidence behind a range of recommendations. The National Institute for Health and Clinical Excellence (NICE) has also published guidance on a number of aspects of diabetic control.
The indicators for diabetes are generally those which would be expected to be done, or checked in an annual review. There is no requirement on the general practitioner (GP) practice to carry out all these items (e.g., retinal screening), but it is the practice's responsibility to ensure that they have been done.
This set of indicators relates to both Type 1 and Type 2 diabetes. Although the care of patients with Type 1 diabetes may be shared with specialists, the general practitioner would still be expected to ensure that appropriate annual checks had been carried out.
If total cholesterol is greater than 5.0 mmol/l, statin therapy to reduce cholesterol should be initiated and titrated as necessary to reduce total cholesterol to less than 5 mmol/l. There is ongoing debate concerning the intervention levels of serum cholesterol in diabetic patients who do not apparently have cardiovascular disease. Further National Guidance is awaited.
The age when a statin should be initiated is unclear. It is pragmatically suggested that the prescription of a statin should be considered for all diabetic patients over the age of 40, particularly if their cholesterol is greater than 5.0 mmol/l. Below the age of 40 a decision needs to be reached between the doctor and the patient and may involve assessment of other risk factors and the actual age of the patient.
Refer to the Scottish Intercollegiate Guidelines Network (SIGN) guideline "Risk Estimation and the Prevention of Cardiovascular Disease" (SIGN Publication No. 97, February 2007) for further information.
