The Wisconsin Medical Society diabetes study.

Problem: Diabetes is a chronic and costly disease affecting approximately 330,000 people in Wisconsin. This study examined the association between use of clinical practice guidelines and outcomes of care.

Methods: Fourteen physicians from 3 diverse sites volunteered to recruit their adult patients with type 1 and type 2 diabetes who were in continuous care in 1999 and 2000. Of 757 randomly selected patients, 492 (65%) completed a mailed survey and 471 (62%) also gave consent for medical record review. Measures included diabetes management indicators, SF-36 scores, and patient satisfaction.

Results: Respondent age averaged 63 years (range 22-90 years) and 55% were men. While most clinicians measured blood pressure, lipids, and hemoglobin (A1c), less than half of the patients were at goal for these indicators. The process indicators explained a significant amount of the variability in physical functioning after controlling for demographics, comorbidities, diabetes-related factors, and clinician type. Overall, most respondents rated their diabetes care as excellent or very good and would recommend their clinician to family and friends.

Conclusions: Study patients with diabetes inconsistently met recommendations for diabetes self-management. While clinical care of study patients was often consistent with recommended guidelines, tremendous opportunities exist for achieving optimal blood pressure, A1c, and lipid levels.