Skip to main content
Log in

A snapshot of type two diabetes mellitus management in general practice prior to the introduction of diabetes Cycle of Care

  • Original Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background

Diabetes is associated with complications, including coronary heart disease, stroke, kidney failure, blindness and amputation, and ultimately is a major cause of disability and death worldwide. Adherence to best practice guidelines is limited in unstructured diabetes management in primary care settings.

Aims

This study aims to establish what data was being collected in general practice prior to the introduction of the Cycle of Care, which is a proactive model of diabetes management introduced in Ireland.

Methods

Medical students in general practices with the University of Limerick Graduate Entry Medical School and their supervisors used practice software to collect quantitative data from the clinical records of patients with T2DM.

Results

The sample included 2696 patients with T2DM who had visited their GP in the previous year. During the 12 months studied, 18.5% of patients with T2DM attended an emergency department and 24% were admitted to hospital. The results of the documentation of three modifiable risk factors associated with T2DM were as follows: 49.5% had BMI documented, 51.7% had smoking status documented and 33.9% had alcohol consumption documented. Two hundred and fifty people were diagnosed with T2DM in the previous 12 months. Of these, 19% had been referred to a chiropodist and 23% to a dietician.

Conclusions

This study provides a comprehensive snapshot of care in Irish general practice for patients with T2DM prior to the introduction of the Cycle of Care. Future research must investigate the impact of Cycle of Care on patient care in general practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Krug EG Trends in diabetes: sounding the alarm. Lancet 387(10027):1485–1486. https://doi.org/10.1016/S0140-6736(16)30163-5

    Article  Google Scholar 

  2. Irish Diabetes Federation (2015) IDF diabetes. International Diabetes Federation. http://www.diabetesatlas.org. Accessed 05/06/2017 2017

  3. Balanda KP, Barron S, Fahy L et al (2010) Making chronic conditions count: hypertension, stroke, coronary heart disease, diabetes. A systematic approach to estimating and forecasting population prevalence on the island of Ireland, Dublin, Ireland

    Google Scholar 

  4. Irish Diabetes Federation (2017) IDF Europe members. International Diabetes Federation. https://www.idf.org/our-network/regions-members/europe/members/140-ireland.html. Accessed 20/06/2017 2017

  5. Stratton IM, Adler AI, Neil HAW et al (2000) Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. Br Med J 321(7258):405–412. https://doi.org/10.1136/bmj.321.7258.405

    Article  CAS  Google Scholar 

  6. Nathan DM, Genuth S, Lachin J et al (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329(14):977–986. https://doi.org/10.1056/nejm199309303291401.doi:10.1056/nejm199309303291401

    Article  CAS  PubMed  Google Scholar 

  7. Diabetes Ireland (2017) Varadkar & Lynch launch new GP Diabetes service. Diabetes Ireland. https://www.diabetes.ie/varadkar-lynch-launch-new-gp-diabetes-service/. Accessed 20/06/2017 2017

  8. HSE (2016) A practical guide to integrated type 2 diabetes care, Dublin, Ireland

  9. Hippisley-Cox J, Coupland C (2015) Development and validation of risk prediction equations to estimate future risk of blindness and lower limb amputation in patients with diabetes: cohort study. Br Med J 351(nov11 1):h5441. https://doi.org/10.1136/bmj.h5441

    Article  Google Scholar 

  10. Mehta S, Mocarski M, Wisniewski T et al (2017) Primary care physicians’ utilization of type 2 diabetes screening guidelines and referrals to behavioral interventions: a survey-linked retrospective study. BMJ Open Diabetes Res Care 5(1):e000406. https://doi.org/10.1136/bmjdrc-2017-000406

    Article  PubMed  PubMed Central  Google Scholar 

  11. O’Connor HF, Saunders J, Dobbs F (2006) Diabetes mellitus in Irish general practice: level of care as reflected by HbA1c values. J Gen Pract 12(2):58–56

    Article  Google Scholar 

  12. O’Connor R, Mannix M, Cullen W, Mullen J, Healy M, Saunders J, Griffin M, O'Sullivan G (2014) Care of type 2 diabetes in unresourced general practice: current practice in the Mid-West. Ir Med J 107(2):43–45

    PubMed  Google Scholar 

  13. ICGP (2011) Primary care teams—a GP perspective. ICGP PCT Report October 2011. ICGP, Dublin

  14. Fisher RF, Croxson CH, Ashdown HF et al. (2017) GP views on strategies to cope with increasing workload: a qualitative interview study. Br J Gen Pract. (655):e148-e156. doi:https://doi.org/10.3399/bjgp17X688861

    Article  Google Scholar 

  15. Hill F, O’Driscoll R, Kearns K et al (2009) Diabetes Audit Report, Dublin, Ireland

  16. Stellefson M, Dipnarine K, Stopka C (2013) The chronic care model and diabetes management in US primary care settings: a systematic review. Prev Chronic Dis 10:26. https://doi.org/10.5888/pcd10.120180

    Article  Google Scholar 

  17. Nolan JJ, O'Halloran D, McKenna TJ, Firth R, Redmond S (2006) The cost of treating type 2 diabetes (CODEIRE). Ir Med J 99(10):307–310

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jennifer V. Gettings.

Appendix 1

Appendix 1

Table 2 Overview of annual check-up, Cycle of Care (adapted from the Department of Health Circular) [7]

Appendix 2

Table 3 Overview of annual follow-up consultation, Cycle of Care (adapted from the Department of Health Circular) [7]

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gettings, J.V., O’Connor, R., O’Doherty, J. et al. A snapshot of type two diabetes mellitus management in general practice prior to the introduction of diabetes Cycle of Care. Ir J Med Sci 187, 953–957 (2018). https://doi.org/10.1007/s11845-018-1754-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-018-1754-9

Keywords

Navigation