The importance of audit: Mary Burden looks at the evidence to support a structured approach to care for people with diabetes and discusses aspects of practice that should be audited to drive forward improvement in outcomes for patients. (Diabetes).

KEY POINTS

* There is increasing evidence that complications of type 2 diabetes can be prevented or at least delayed.

* Audit is an effective way of identifying at-risk patients with diabetes, and part of the role of the practice nurse in secondary prevention.

People with diabetes should be involved in setting priorities for their care and lifestyle modification. The benefits of regular recall and review of diabetes patients is well established.

There is increasing evidence that type 2 diabetes can be prevented or at least delayed. This comes from worldwide research, (1,2) which aimed to identify people with impaired glucose tolerance (IGT) and initiated exercise programmes that encouraged people to lose weight. Increased levels of exercise and weight loss have been recognised by the Diabetes National Service Framework (3) as Standard 1 in the prevention of type 2 diabetes and are issues that are likely to be addressed by practice nurses.

People who have been identified as having IGT should be recalled after a set period, such as one to three years for further tests or sooner if they experience symptoms of diabetes. This group are also at high risk of cardiovascular disease, (4) so should be involved in any local cardiovascular risk reduction programmes.

IDENTIFYING PEOPLE WITH DIABETES

The number of patients in your practice who have diabetes obviously depends on the size of your practice population. However, if your practice population is older, with significant numbers of people of Indo-Asian or Afro-Caribbean origin, (5) who may be socially deprived, (6) then there will be significantly more people with diabetes. You can calculate how many people you should be seeing in your diabetes clinic by using the Trent Public Health Observatory website. (5)

Most people with diabetes have type 2 diabetes. This is often thought to be less serious than type 1 diabetes, but people with uncontrolled type 2 diabetes, which is often associated with hypertension and dyslipidaemia, have just as many health problems due to complications such as cardiovascular disease, retinopathy, neuropathy and nephropathy. (7)

Other studies have shown that complications are not inevitable and can be prevented. (8,9,10) Practice …