Complications from type-2 diabetes down 80%, says report

A care programme for managing type-2 diabetes by general practitioners has reduced complications from the disease by 80%.

An audit report of the Midland Diabetes Structured Care Programme also found that major savings can be achieved in the management of diabetes by GCPs.

GP lead for the study Dr Velma Harkins said the results of the programme, which began in 1998, were very encouraging.

The audit involved more than 3,700 patients in 30 general practices across Longford, Westmeath, Laois, and Offaly.

Patients are proactively managed through four GP visits a year.

Dr Harkins said there was an 80% reduction in eye, kidney, and feet complications in patients and a 94% reduction in heart-related complications between 2003 and 2016.

The report, published by the Irish College of General Practitioners, also shows that GPs kept patients’ weight stable.

“The programme serves as an example of what can be achieved through proactive primary-care management,” said Dr Harkins.

Unlike episodic unstructured care, this approach delivered real results.

Supported by the HSE through Hearthwatch, it is the longest-running programme of its type in the State.

Dr Harkins said the programme could be easily extended nationally and the cost involved would be about €5m a year.

“It costs around €900m annually to treat the complications in patients with type-2 diabetes,” she said.

“If not well managed, this type of diabetes can lead to debilitating conditions including visual impairment and blindness, lower limb amputations, kidney failure, and heart disease.”

Dr Harkins said patients were happy to participate in the programme. Unlike hospital visits, there was no delay in getting an appointment.

It was all about structuring their care so they could get the best outcomes. However, patients could choose whether they wanted to have their diabetes managed by their GP or in a hospital setting.

Practices involved in the programme are registered, recalled, and subject to regular review.

Type-2 diabetes that is linked to obesity is expected to increase by up to 62% by 2020. Currently, there are more than 200,000 people with diabetes in Ireland.

The programme compares well with Britain, where existing policy, including a pay-for-performance initiative, supports diabetes care at the practice level.

Health Minister Simon Harris said he would like to see the programme extended but to do so, a new GP contract has to be put in place.

“Patients need to have access to safe and clinically effective treatments early, as close to their home as possible and at the lowest level of complexity,” said Mr Harris.

ICGP chair Dr Richard Brennan said the audit was a significant piece of research.

It showed how a primary care-led model of care could perform over time and how it could be delivered effectively on a national level.

Dr Brennan said it could be included as part of the integrated care programme in prevention and management of chronic disease.


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