Adherence to recommended standards of diabetes care by Swiss primary care physicians

Objectives:: To assess adherence to recommended standards of diabetes care by Swiss primary care physicians. Methods: Medical files of community-based primary care physician were reviewed to assess adherence to recommended standards of diabetes care. These standards of care were based on a uniform set of definitions addressing medical care processes involved in the detection and follow-up of pre-diabetic and diabetic patients. Results: 186 physicians agreed to participate and 3,682 medical files were assessed. The prevalence of diabetes was 11% and 5% had impaired glucose tolerance (pre-diabetic). Screening of diabetes based on family or personal history was reported for 83% of the patients and on cardiovascular risk factors for 69%. Counselling for dietary changes was reported for 91 % of diabetic patients and for 79% for physical activity, but only for 66% and respectively 60% of pre-diabetic patients. Among diabetic patients, regular HbA(1c) control was reported for 65 %, yearly fundoscopy for 62 %, yearly feet examination for 65%, yearly microalbuminuria control for 49%, regular blood pressure control for 96%, and yearly lipid profile for 89%. Regular screening of microanglopathic complications was reported for only 33% of diabetic patients. Conclusion: Adherence to recommended standards of diabetes care displayed important variations among this convenience sample of Swiss priniary care patients. Screening and counselling of diabetic patients were frequent, whereas counselling for lifestyle changes of pre-diabetic patients and regular follow-up of microanglopathic complications among diabetic patients were suboptimal. These results could help to target areas of diabetes care that need to be addressed to improve adherence to recommended standards.