Health care delivery in type 2 diabetes. A survey in an Italian primary care practice

• The paper analyzes the quality of diabetic care provided by an Italian primary care practice.
• HbA1c was >8% in 22% of patients and that figure did not change during the follow-up.
• SBP and LDL-C was at target in a minority of patients.
• Only a third of patients was prescribed statins.
• Efforts are needed to improve the management of type 2 diabetes in primary care.

AimsEvidence-based guidelines provide targets and performance measures for the treatment of type 2 diabetic patients but a wide gap separates guidelines-driven recommendations from their clinical application, a phenomenon hindering the transfer of proven benefits to affected populations.MethodsWe analyzed the quality of diabetic care delivered by 8 general practitioners joint in a group practice attending 571 diabetic patients (5.6% of the total enlisted subjects) by assessing process (% of HbA1c, SBP and LDL-C determinations) and intermediate outcome (% of patients with HbA1c <7% vs >8%, systolic BP <130 mmHg vs >140 mmHg, LDL-cholesterol <100 mg/dL vs >130 mg/dL) indicators.ResultsHbA1c was at target in 49% of patients and >8% in 22%; SBP and LDL-C determination was available in about two-thirds of patients, only a minority at target for SBP and LDL-C. Antihyperglycemic and antihypertensive treatment was prescribed in most patients but only a third was on statins. During the post-evaluation phase, percentages of patients with HbA1c >8%, SBP < 130 mmHg and LDL-C < 100 mg/dL and the drug prescription pattern did not change.ConclusionsSeveral weaknesses affect primary care delivery to type 2 diabetic patients and efforts are needed to improve the management of this high-risk group.