Improving Diabetes Care

Diabetes is one of the most demanding chronic diseases in terms of control. If the blood glucose levels are not adequately controlled, numerous complications ensure – gangrene of the feet, kidney failure, blindness, heart attack, and stroke. To achieve good control the insulin dose must be titrated, adapting to changes in diet and exercise, so that glucose levels are neither too high, nor too low. It is also important to keep blood pressure and blood lipids under control. One day this will all become much easier because ‘artificial pancreases’, which automatically carry out the required titration, are coming into service.[1] In the meantime, diabetes remains the ultimate quality control challenge. Individual quality control methods such as patient education, peer support, and provider support have been evaluated in over 150 RCTs.[2] There have also been a number of trials of multi-component interventions. The most recent of these [3] is interesting because the intervention was targeted at the provider (decision support) and at the patient (care co-ordinators). It was carried out in South Asia and patients were followed up for two and a half years. Only patients with poor control were eligible. The intervention was highly successful; the risk of ‘poor control’ (defined in terms of HbA1c, a long-term marker for glucose control) was halved in the intervention group. The positive effect was present with and without imputation for missing data.

— Richard Lilford, CLAHRC WM Director


  1. Sheng E. The Artificial Pancreas is Here. Scientific American. November 2016.
  2. Tricco AC, Ivers NM, Grimshaw JM, et al. Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysisLancet. 2012; 379: 2252-61.
  3. Ali MK, Singh K, Kondal D, et al. Effectiveness of a Multicomponent Quality Improvement Strategy to Improve Achievement of Diabetes Care Goals. Ann Intern Med. 2016; 165: 399-408.

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