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

tAims: Evidence-based guidelines provide targets and performance measures for thetreatment of type 2 diabetic patients but a wide gap separates guidelines-driven recom-mendations from their clinical application, a phenomenon hindering the transfer of provenbenefits to affected populations.Methods: We analyzed the quality of diabetic care delivered by 8 general practitioners jointin a group practice attending 571 diabetic patients (5.6% of the total enlisted subjects) byassessing process (% of HbA1c, SBP and LDL-C determinations) and intermediate outcome (%of patients with HbA1c8%, systolic BP 140 mmHg, LDL-cholesterol130 mg/dL) indicators.Results: HbA1cwas at target in 49% of patients and >8% in 22%; SBP and LDL-C determinationwas 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 butonly a third was on statins. During the post-evaluation phase, percentages of patients withHbA1c>8%, SBP < 130 mmHg and LDL-C < 100 mg/dL and the drug prescription pattern didnot change.Conclusions: Several weaknesses affect primary care delivery to type 2 diabetic patients andefforts are needed to improve the management of this high-risk group