Diabetes mellitus in Irish general practice: Level of care as reflected by HbA_1c values

Objective: To assess the level of care given to people with diabetes by general practitioners and factors affecting it. Methods: A cross-sectional study of Irish general practitioners, looking at practice characteristics and patient care over the previous 2 years; a nationally representative sample of 27 general practitioners. A total of 1030 people with diabetes were studied, of whom 201 were type 1 and 829 were type 2. Results: The response rate was 27 out of 52 (52%). HbA_1c values were not related to the patient's socioeconomic status. The average HbA_1c for type 1 people with diabetes was 7.81%, and for type 2 it was 7.1%. HbA_1c values were measured 3.02 times for type 1 and 3.16 times for people with type 2 diabetes. This is a good standard of care, especially for type 2 disease. Computerized practices and those patients whose care was shared with the hospital achieved better control, even though HbA_1c levels were checked less frequently with computerization. The use of a protocol in the practices also improved care. Those practices employing a nurse had increased frequency of measurement of HbA _1c and better control on univariate but not on multivariate analysis. Possible reasons for this are discussed. Conclusion: Diabetes Mellitus is treated to a good standard in Irish general practice, especially type 2 disease. This standard appears to be independent of the patient's socio-economic status, is improved by GPs being computerised, in group practices and by providing care according to a protocol. Shared care also improves control. Employing a practice nurse may also improve care.