Integrated care for diabetes

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6949.275 (Published 23 July 1994) Cite this as: BMJ 1994;309:275
  1. P Chedin,
  2. J Cahen-Varsaux
  1. Department of Diabetology, Hospital Victor Dupouy, 95107 Argenteuil Cedex, France.

    EDITOR, — The Diabetes Integrated Care Evaluation Team reports a comparison of integrated care versus conventional care for diabetes.1 In our opinion the results of this study cannot be generalised to all diabetic patients, even if the exclusion criteria are taken into account. The mean glycated haemoglobin concentration when the patients were recruited is impressive, being nearly normal (5.3% ISD 1.4%); normal <5.3%); it is evidence of good metabolic control before the trial. In the diabetes control and complications trial the mean glycated haemoglobin concentration at recruitment varied from 8.8% (1.6%) to 9.0% (1.5%) (normal value 1.05% (0.5%).2 After two years the value in the intensive therapy group had fallen to about 7%, thus remaining clearly above normal.

    The degree of glycaemic control among non-insulin dependent patients who receive conventional care is not well known. The United Kingdom prospective diabetes study should answer this question next year. Nevertheless, in that study the median glycated haemoglobin concentration over three years varied from 6.2% to 6.2%,3 with exclusion criteria at recruitment similar to those of the diabetes integrated care evaluation study. In France, Guillausseau et al reported a mean glycated haemoglobin concentration of 8.4% (1.9%) in 246 non-insulin dependent patients and of 9.3% (1.9%) in 125 insulin dependent patients attending a diabetic clinic normal value 6.2% (0.7%).4 We would therefore he interested to know the training programme of the traditional hospital clinic model in the Aberveen Health Centre. We think that the statement that “the model of integrated care for diabetes is at least as effective as conventional hospital clinic care” applies only to diabetic patients with good metabolic control.


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