Quality Standards for Diabetes Care Toolkit

Introduction

Cardiovascular disease morbidity and mortality rates are two to five times higher in people with diabetes compared to people without diabetes. Women with diabetes have a higher relative risk of death from cardiovascular disease when compared to men with diabetes, however the absolute risk is lower. The excess mortality associated with diabetes is evident in all age groups but is particularly high in young people with type 1 diabetes (Scottish Intercollegiate Guidelines Network 2010). Young people with type 2 diabetes are at increased of greater mortality, more complications and unfavourable cardiovascular risk factors compared to young people with type 1 diabetes (Constantino et al 2013).
The traditional clinical consultation involves the gathering, sharing and discussing information, deciding the issues, and developing a plan. Care planning in addition involves encompassing the patient views and including a much wider range of issues across all aspects of a person’s life. It takes into account their condition, and their personal goals are central to the action plans developed. In diabetes, care planning replaces the traditional annual review which can become a ‘tick box’ activity, with a ‘conversation’ that is more satisfactory and effective for everyone (Diabetes UK, NHS National Diabetes Support Team, Department of Health, and Health Foundation 2008).
When setting targets or goals, these should be specific to the individual, and set as part of the process of the care planning while assessing the clinical needs of the patient. The specific goals and expectations will differ significantly between a healthy 26-year-old and a frail 86-year-old with diabetes related complications (Chiang et al 2014).
People with diabetes are at increased risk of developing micro and macrovascular complications, plus poor glycaemic control and/or hypertension may impact on the advancement or management of co-morbidities or co-existing conditions. The New Zealand Primary Care Handbook (2012, p 49) states that an annual assessment for determining level of risk for macrovascular and microvascular complications is a key component of treatment planning and target setting for each individual with type 2 diabetes.
It notes that:

the risk of complications varies greatly across the diabetic population

the aim is prevention of complications, especially targeting those at high risk

patients with existing complications (eg, foot, eye, kidney or cardiovascular disease) are in a high-risk category and should be managed intensively