The Winding Road to Health of People with Diabetes

Health statistics influences policies and resource allocation on the basis of health needs and system performance. The evaluation of the outcomes of health care is now based not only on changes in the morbidity and mortality of the population, but on a more comprehensive assessment of the trends in health. Demand for high-quality and timely data for reporting on country progress has led to proliferation of indicators (either clinical or performance), i.e. measurable aspects of care provided for which there is evidence that they represent quality on the grounds of scientific research or consensus among expert. Is time to develop a coherent system of data collection, analysis and use that meet country and international needs. Both individual characteristics (age, gender, income, education, occupational status, and social network) and societal features (gross domestic product per capita) influence health. Self-reported health covers physical, mental, and social aspects of health; it has proven to be a powerful predictor of morbidity and mortality and to be associated with the number of contacts with physician per year. The European Social Survey evaluated both individual- and country-level factors in examining health differences between 21 European countries. Guidelines for diabetes provide evidence-based recommendations for management of diabetes in adults (control of haemoglobin A1c, blood pressure and lipid levels) whose goals are to improve quality of care, decrease morbidity, mortality, and costs by reducing complications, and improve quality of life for diabetic people. Diabetes quality indicators based on diabetes guidelines have been developed which were focused on process measures or on risk factor levels reported one at a time. Glycaemic, blood pressure, and lipid control are the principal specific indicators; other evaluation recommended include annual foot examination, annual tests for diabetic nephropathy, retinopathy, and neuropathy as well as smoking cessation counselling. Indicators may be examined separately; yet a summary measure of “diabetes risk factor control” should be useful for quality measurements. Quality-adjusted life years (QALYs) has been used as a composite measure of the clinical value attributable to better control of the three major risk factors: haemoglobin A1c, low-density lipoprotein-cholesterol and systolic blood pressure. Moreover, several quality initiatives are trying to establish an incentive for improved diabetes care. Achieving and documenting guidelines goals requires an organised system of diabetes care delivered by a multidisciplinary diabetes care team. However, some questions need special attention. First, how many countries have ideally organised health systems where diabetes care is delivered by multidisciplinary teams? Second, risk factor differences estimated by quality measured should be sustained over time to effectively prevent diabetic complications. Thus, examination surveys have to be done regularly. Third, both perceived health and quality of life have not been included among diabetes quality measures. Quality measurement remains prerogative of health care providers while diabetic people continue to be not actively involved in the care provided and in its evaluation.