The National Diabetes Advisory Board recommends that diabetes prevention and control programs focus on the preventable complications of diabetes, i.e., visual impairment, lower-extremity problems, renal problems, ketoacidosis, and adverse outcomes of pregnancy. The Florida Diabetes Control Program chose to focus its efforts on the first three of these complications at the federal- and state-funded primary-care programs in Florida because these programs had access to targeted, public-sector patients and because of fiscal restraints that make the care provider the logical source of entry to the health-care system. This study sought to document the current level of care for complications of diabetes in primary-care settings, provide state-of-the-art professional education along with patient education, and evaluate changes in practice habits. Three intervention and three control primary-care centers were selected. Medical records in each center were reviewed over a 2-yr period. At intervention sites, retinopathy referrals increased from 9 to 43% (P < .001), urinalyses increased from 69 to 94% (P < .001), and examinations of lower extremities increased from 66 to 94% (P < .001). There were no such changes in the control sites. Hypertension was diagnosed in nearly two-thirds of patients, and a last blood pressure of >140 mmHg systolic or >90 mmHg diastolic was present in 64% of the intervention group at yr 1 and declined to 56% at yr 2 (P < .05). The following problems were identified. 1) Despite referrals to ophthalmologists approaching 100%, the actual rate of compliance was only 43%. 2) Significant hypertension existed after intervention. 3) The clinic drop-out rate was 37% after only 1 yr. This study documents the actual care delivered in this sector of medicine and the willingness of providers to change practice habits to comply with recommended standards.

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