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Improvements in Diabetes Care: International Experiences |

Management of Non-Insulin-dependent Diabetes Mellitus: The United Kingdom Experience

Harry Keen, MD, FRCP
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From UMDS, Guy's Hospital, and the British Diabetic Association, London, United Kingdom. For the current author address, see end of text. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “Risks and Benefits of Intensive Management in Non-Insulin-dependent Diabetes Mellitus: The Fifth Regenstrief Conference.” To view a complete list of the articles included in this supplement, please view its Table of Contents. Requests for Reprints: Professor Harry Keen. Unit for Metabolic Medicine, Hunts House, UMDS, Guy's Hospital. London SE1 9RT, United Kingdom.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1996;124(1_Part_2):156-159. doi:10.7326/0003-4819-124-1_Part_2-199601011-00015
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Care of persons with non–insulin-dependent diabetes mellitus (NIDDM) in the United Kingdom resembles that in the United States. However, health care practice in Europe is being influenced by the Saint Vincent Declaration, the joint European World Health Organization-International Diabetes Federation initiative, which emphasizes prevention of diabetic complications. In recent years, the responsibility for care for NIDDM has shifted in the United Kingdom to general practice teams. The effect of this shift on the quality of care and the coordinating and educational role of local diabetes specialist teams is discussed, as is the importance of an individualized “menu” of care for each patient. This menu aims for optimum blood glucose level control as well as detection and correction of risk factors for diabetic complications. The pervasive and dangerous notion of NIDDM as a “mild” disease must be corrected. The importance of systematic auditing of process and outcomes in diabetes care is emphasized, as is the need for regular data acquisition, aggregation, and analysis to achieve continuous improvement in the quality of care. Although patient-health professional encounters are the core of good diabetes care, the need for larger-scale appraisal on a local, regional, and national basis is now apparent.

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