We congratulate Daren Lin and colleagues for their proactive approach to improving diabetes management in their community.
We too have found that simple tools can substantially affect both testing frequency and metabolic outcome measures. We have been operating a program in the Central Okanagan region of British Columbia for people with diabetes and their physicians since January 1, 2002. The program is administered by Valley Medical Laboratories, a community medical laboratory. Planning is done with the assistance of an advisory group of 7 family physicians. By creating a registry and offering a program that is well received by both physicians and those affected by diabetes, we believe that diabetes management has been positively influenced in the Central Okanagan.
Although most new patient registrations come directly from physicians’ offices, twice yearly we inform physicians of potential candidates identified by review of laboratory test results. Once registered, people with diabetes who choose to participate in the program are scheduled for testing according to the 2003 Canadian Diabetes Association Guidelines. Those who fail to attend as scheduled receive up to 2 reminder letters by mail. Those who do attend receive a personalized patient progress report by mail within 1 week of laboratory testing. The report includes the following:
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the 2 most recent AIc results,
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the most recent systolic blood pressure measurement,
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the most recent lipid results (low-density lipoprotein, risk ratio),
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explanations of the different tests, including targets,
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a reminder of the next scheduled testing date, and
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a reminder of the importance of an annual eye examination. Since inception, our program has achieved the following:
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91% of the presumed number of people with diabetes in the Central Okanagan have been identified and registered,
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69% of those registered participate actively in the program,
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98% of family physicians practising in the area actively participate,
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90% of participants had 2 or more tests in 2006 (compared with 35% of non-participants), and
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65% of participants’ results were =7% in 2006 (compared with 55% of non-participants’ results).
A laboratory-administered program that supports self-management by offering simple reminders and direct reporting of results to people with diabetes seems to enhance achievement of recognized metabolic targets and of testing frequency recommendations.
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