Quality Standards for Diabetes Care Toolkit

Introduction

Diabetes and cardiovascular disease (CVD) affect a growing number of New Zealanders each year and have a disproportionate effect on Māori, Pacific people and people of South Asian origin. These diseases affect New Zealanders’ quality of life and life expectancy, and the impact is increasing with an ageing population and lifestyle changes. (Ministry of Health 2011, p 2). Good glycaemic control has benefits for microvascular outcomes and, if started early enough, on long term macrovascular outcomes. It is recommended that individualised HbA1c targets be set by individuals and clinicians in partnership, taking into consideration the potential duration of the individual’s exposure to hyperglycaemia. The New Zealand Primary Care Handbook 2012 indicates that, in general, a target of 50–55 mmol/mol is appropriate but individual factors, particularly age, should be considered when setting targets.
Tighter control should be considered for younger people due to their higher lifetime risk of diabetes-related complications (New Zealand Primary Care Handbook 2012). HbA1c levels should be monitored regularly to assess whether targets are being met and to enable review if not (Best Practice Advocacy Centre 2013). It has long been accepted that there is a relationship between diabetes and cardiovascular disease (CVD) and a significant number of people have both conditions. People with type 2 diabetes are two to four times more likely to suffer from CVD, which is the main cause of death in people with diabetes (Ministry of Health 2011). It is suggested that fewer than 10% of diabetes patients in the US reach their goals for systolic blood pressure, LDL cholesterol and HbA1c. Clinicians’ failure to intensify medication therapy, despite elevated CVD risk factors, is a primary reason (Schmittdiel et al 2008).