Education And Debate

Lesson of the Week: Diabetic patients who do not have diabetes: investigation of register of diabetic patients in general practice

BMJ 1994; 308 doi: (Published 07 May 1994) Cite this as: BMJ 1994;308:1225
  1. P Patchett,
  2. D Roberts
  1. Waterloo House Surgery, Millom, Cumbria LA18 4DE
  1. Correspondence to: Dr Patchett

    The care of patients with non-insulin dependent diabetes mellitus is often considered the responsibility of general practitioners.*RF 1-3* Organising such care usually entails setting up a diabetic register, standardising care,4 and then performing an audit.5 While auditing our diabetic care we noted that some patients' serial glycated haemoglobin (HbA1) concentrations were all normal or nearly so. We decided to investigate whether these patients actually had diabetes.

    Patients and methods

    Our practice serves an isolated community of 8770 patients. A diabetic register was established in 1983. Although no formal criteria were used for entry, most patients had results from a blood glucose test (random, fasting, or postprandial) or an oral glucose tolerance test. A written management protocol was agreed in 1987; this included checking HbA1 concentrations in all patients every three months.

    An audit of diabetic care was performed in October 1992. Patients with normal or near normal serial HbA1 concentrations were noted and their records examined. Those with no clear clinical evidence of diabetes …

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