Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
Research ArticleCurrent Practice

Enhancing diabetes care in family practice

A flow sheet

Beata Patasi and James R. Conway
Canadian Family Physician September 2008, 54 (9) 1237-1238;
Beata Patasi
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
James R. Conway
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • CFPlus
  • eLetters
  • Info & Metrics
  • PDF
Loading

According to statistics 87% of care for type 2 diabetes in Canada is provided by primary care practitioners. 1–4 Research has shown, however, that this care does not meet the standards achieved by specialists. In an attempt to close the gap, we have designed a Diabetes Flow Sheet (using Canadian Diabetes Association [CDA] clinical practice guidelines [CPGs]) to assist primary care practitioners in treating their patients with diabetes and to provide ongoing feedback, helping primary care practitioners to attain and maintain compliance with evolving CPGs.5

Gap in treatment

Various studies in Canada have shown that there is a substantial gap between CDA guidelines and the actual standards of practice in family medicine in Canada.2,6 In Canada, only 51% of patients with diabetes achieve the target glycosylated hemoglobin A1c (HbA1c) levels of less than 7%.6 Failure to achieve guideline values leads to increased morbidity and mortality in patients with diabetes.4,7–15 There are challenges in maintaining optimal diabetes care in rural and isolated practice settings, where opportunities for medical education and support are limited.

Diabetes flow sheet

The Canadian Centre for Research on Diabetes is a not-for-profit organization committed to improving outcomes in patients with diabetes by providing education and support for patients and their health care providers. As such, we have designed a flow sheet that is easy to use, gives family practitioners a structured care approach, and includes CDA-CPG goals and intervals (Figure 1).*

Our intention is to support and help primary care practitioners in small, rural, or isolated practices who are without sophisticated electronic support. It is a fairly simple process: The flow sheet, after being filled out after each visit, is faxed to the Canadian Centre for Research on Diabetes (with the patient’s consent). The physician’s details and the patient’s demographic data are coded into the record form, as well as family history, smoking history, year of diagnosis, and dates of last eye and foot examinations. A diagnostic template reminds the physician of commonly occurring comorbidities (such as type 2 diabetes, obesity, hypertension, dyslipidemia, nephropathy, neuropathy, retinopathy, depression, erectile dysfunction, coronary artery disease); the patient’s medications (including dosage and start date) and investigations or laboratory results are then entered or checked off in the appropriate places. Staff members enter the data into a computer system, which is reviewed by a physician. All values that fall outside of the target levels of the CDA guidelines are printed in red. If there are any CDA recommendations that might be applicable to a particular patient, they are printed on the bottom of the form in a contrasting colour. A new, updated, and coloured form is reprinted and mailed back to the attending physician; the new form is placed in the patient’s chart and the old form can then be destroyed. The flow sheet is cumulative and allows ongoing assessment of progress toward achieving guideline-compliant care of patients with diabetes. The back of the flow sheet can be used for objective guideline-directed educational initiatives and can be geared toward individual physicians.

Multiple benefits

Use of this tool results in a win-win situation:

  • Primary care practitioners win because they have access to care guidelines and directed assistance to achieve guideline targets. Physicians have a tool that is practical and easy to use.

  • Periodic analyses of practice standards for individual physicians allows for directed physician education.

  • Patients’ treatment plans are continuously audited and suggestions are frequently made to help achieve targets, improving outcome and reducing morbidity and mortality.

  • The Canadian Centre for Research on Diabetes is allowed to keep a live database of current treatment standards in Canada and can design educational programs based on need. The data on physicians and individual patients are strictly confidential but the aggregate data can be periodically published.

Assessment

The project was tested by 25 physicians in northern Ontario, all who were in solo or small group community practices. Up to 330 patients with diabetes were enrolled, with an average age of 43.6 years and a patient split of 46% male to 54% female. The average duration of diabetes to date was 8 years.

Upon entry—ie, first visit—the average fasting glucose level was 11.3 mmol/L; average HbA1c level was 7.9%; average low-density lipoprotein cholesterol level was 2.6 mmol/L; 62% of subjects were using angiotensin-converting enzyme inhibitors; 11% were using angiotensin II receptor blockers; 48% were using statins; and 76% were using acetylsalicylic acid.

At last visit, average fasting blood sugar level was 7.7 mmol/L; average HbA1c level was 5.6%; average low-density lipoprotein cholesterol level was 1.7 mmol/L; 95% of subjects were using angiotensin-converting enzyme inhibitors; 32% were using angiotensin II receptor blockers; 75% were using statins; and 95% were using acetylsalicylic acid.

Overall, these participating physicians did improve standards of care and guideline compliance in their respective practices as a result of this project.

Confidentiality

Individual patient data are used only on the flow sheets, which are returned to the attending physicians. Physician data are only used to generate confidential reports to the individual physicians.

Confidential reports can be generated for individual physicians that show their degree of compliance with important CPG recommendations and compare their results with those of other participating physicians. All patient and physician information is confidential, but reports on national and regional standards might be published to assist in the provision of targeted educational initiatives and to demonstrate standards of care.

Conclusion

This program is offered nationwide. If you think the flow sheet would be beneficial to you, your practice, or your patients, simply download a copy of the form and begin. Fax the first form to the number provided; when we return the reprinted form, we will enclose extra blank forms for future use.

The form is available for download (Figure 1)* or can be found on our website at www.diabetesclinic.ca in the “Tools and Forms” section. We also encourage your feedback; call 800 717-0145 should you have any questions, concerns, or commentary.

Footnotes

  • Competing interests

    None declared

  • Copyright© the College of Family Physicians of Canada

References

  1. ↵
    WorrallGFreakeDKellandJPickleAKeenanTCare of patients with type II diabetes: a study of family physicians’ compliance with clinical practice guidelinesJ Fam Pract199744437481
    OpenUrlPubMed
  2. ↵
    HarrisSBStewartMBrownJBWetmoreSFauldsCWebster-BogaertSType 2 diabetes in family practice. Room for improvementCan Fam Physician20034977885
    OpenUrlAbstract/FREE Full Text
  3. Canadian Medical Association. Physician resources database.Ottawa, ONCanadian Medical Assocation2000Available from: www.cmaj.ca. Accessed 2008 Aug 11
  4. ↵
    RourkeJChapter 25. Rural practice in CanadaGeymanJPNorrisTEHartLGTextbook of rural medicine.New York, NYMcGraw-Hill Professional2000395410
  5. ↵
    Canadian Diabetes AssociationClinical practice guidelines 2003Toronto, ONCanadian Diabetes Association2003Available from: www.diabetes.ca/cpg2003. Accessed 2008 Jul 21
  6. ↵
    HarrisSBPetrellaRJLambert-LanningALeadbetterWCranstonLLifestyle management for type 2 diabetes. Are family physicians ready and willing?Can Fam Physician200450123543
    OpenUrlAbstract/FREE Full Text
  7. ↵
    HarrisSBEkoéJMZdanowiczYWebster-BogaertSGlycemic control and morbidity in the Canadian primary care setting (results of the diabetes in Canada evaluation study)Diabetes Res Clin Pract2005701907
    OpenUrlCrossRefPubMed
  8. SowersJRDiabetes mellitus and cardiovascular disease in womenArch Intern Med1998158661721
    OpenUrlCrossRefPubMed
  9. The Diabetes Control and Complications Trial Research GroupThe effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitusN Engl J Med19933291497786
    OpenUrlCrossRefPubMed
  10. UK Prospective Diabetes Study (UKPDS) GroupIntensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)Lancet1998352913183753
    OpenUrlCrossRefPubMed
  11. StrattonIMAdlerAINeilHAMatthewsDRManleySECullCAAssociation of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational studyBMJ2000321725840512
    OpenUrlAbstract/FREE Full Text
  12. UK Prospective Diabetes Study GroupTight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38BMJ1998317716070313
    OpenUrlAbstract/FREE Full Text
  13. KoskinenPMänttäriMManninenVHuttunenJKHeinonenOPFrickMHCoronary heart disease incidence in NIDDM patients in the Helsinki Heart StudyDiabetes Care19921578205
    OpenUrlAbstract/FREE Full Text
  14. PyoräläKPedersenTRKjekshusJFaergemanOOlssonAGThorgeirssonGCholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart diseaseDiabetes Care199720461420
    OpenUrlAbstract/FREE Full Text
  15. ↵
    AdlerAIStrattonIMNeilHAYudkinJSMatthewsDRCullCAAssociation of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational studyBMJ200032172584129
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

Canadian Family Physician: 54 (9)
Canadian Family Physician
Vol. 54, Issue 9
1 Sep 2008
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Enhancing diabetes care in family practice
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Enhancing diabetes care in family practice
Beata Patasi, James R. Conway
Canadian Family Physician Sep 2008, 54 (9) 1237-1238;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Enhancing diabetes care in family practice
Beata Patasi, James R. Conway
Canadian Family Physician Sep 2008, 54 (9) 1237-1238;
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Gap in treatment
    • Diabetes flow sheet
    • Multiple benefits
    • Assessment
    • Confidentiality
    • Conclusion
    • Footnotes
    • References
  • Figures & Data
  • CFPlus
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • More clinical care: survey
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Scurvy
  • Intraprofessional relationships
  • Question: Can you identify this condition?
Show more Current Practice

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • RSS Feeds

Copyright © 2023 by The College of Family Physicians of Canada

Powered by HighWire