Optimizing diabetes care: perspectives from a practical view point

Mainous et al. highlight some important aspects with regard to the intricacies in the provision of diabetes care depending on the health care delivery system. ¹ In the UK, however, what we experience is only a tip of the iceberg if we take into consideration:

1. (1)

   The findings of the national diabetes audit, which suggested that a quarter of people with diabetes remain undiagnosed;

2. (2)

   The high coexistence of hypertension with diabetes, which in itself is a becoming a global public health challenge with implications for vascular risk;

3. (3)

   The burden of disease and the burden of cost of disease;

4. (4)

   The discrepancies in physicians’ choice of therapy; and

5. (5)

   The proportion of patients with a glycosylated haemoglobin <7.4% having increased only non-significantly from 37.9 to 39.7% (P=0.19) over five years, suggesting that glycaemic control per se has to get better, and needs to be addressed even further. ²

These issues become all the more pertinent if we take into account other aspects of diabetes care, such as maternal health and the role of deranged glucose metabolism from a cardiovascular perspective.^3-5 Other important issues include diabetes care provided in the community, such as eye screening and foot care.

Indeed, the pathophysiology of complications in the setting of diabetes is multifactorial, and in addition to the predictable risk factors, there are many other closely interrelated processes that develop in parallel, progress with time, and are robustly and individually associated with the risk of death on a background of diabetes.^2,4 The concept of using national diabetes registers should be recognized as a good role model to advance surveillance, and the new contract for general medical services introduced in 2004 constitutes the biggest change in UK primary medical care for many decades. ² Hopefully, the results can only be even more rewarding and impressive for this growing epidemic and things will only get better.