The management of diabetes

Moving beyond registration, recall, and regular review

Primary Care p 970

Over the past 30 years care of diabetes has been in the vanguard of the change in the management of chronic diseases from specialties based in hospital outpatient clinics to a more primary care led service. The specialist versus generalist debate is sterile; there is greater variation in outcomes within than between traditional disciplinary boundaries. Effective delivery of care to people with diabetes over this period has depended on the three Rs of management of chronic diseases—registration, recall, and regular review.1

A well conducted trial from Danish general practice published in this issue (p 970) underlines this and supports the findings of a subsequent Cochrane review that multifaceted interventions to improve the performance of practitioners, and organisational interventions to improve recall and review, can enhance the care of diabetes. 2 3 Three hundred and twelve practices were randomised to intervention and routine care groups. In the intervention group 243 general practitioners (practice nurses are scarce in Denmark) were given leaflets for patients, guidelines, annual seminars, and feedback and were prompted to review patients and …