Primary Care Management of Patients

Published Date: 19th July 2016

Publication Authors: Conrad D, McNulty S

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Aims:  Evidence-based management of patients with IGR is essential in reducing the incidence of Type 2 diabetes. The estimated adult prevalence of IGR is 2.3%. Without intervention, the majority of IGR patients are likely to develop Type 2 diabetes within five–10 years. A clinical audit was conducted to identify current practice in the management of IGR and the history of gestational diabetes in primary care across Merseyside, England.

Methods:  In September 2011, data were extracted using standardised clinical searches run in 63% of Merseyside general practices (n = 148), covering 61% of the registered adult population (n = 618,602). The searches identified both patients diagnosed with IGR and patients with a history of gestational diabetes. The recorded prevalence of IGR was 0.82% [95% confidence interval (CI) 0.80%–0.85%], with a range between practices of 0.00%–4.59%. In total, 908 patients were diagnosed with IGR following a fasting plasma glucose (FPG) test in 2009, of whom 65.75% (95% CI 62.60%–68.76%) did not receive a follow- up FPG test during 2010; 802 patients had a recorded history of gestational diabetes, of whom 78.42% (95% CI 75.45%–81.13%) had not received a follow-up FPG test in the last 12 months. Of patients with IGR 81.88% (95% CI 80.79%–82.91%) were overweight or obese, 0.82% of whom had a documented referral to lifestyle services (95% CI 0.59%–1.11%).

Conclusions:  The variation between practices in identification, poor levels of follow-up and documented referral into lifestyle services suggest that a local IGR pathway, along with additional activity and improved data recording, are required across Merseyside. 

Acknowledgement:  The clinical audit was contucted with the support of GP diabetes leads across Merseyside and was done as part of the Merseyside Diabetes QIPP.

Du Plessis, RA; Conrad, D; McNulty, S; Williamson, C. (2013).  Clinical audit: To review the primary care management of patients with impaired glucose regulation (IGR) across Merseyside . Diabetic Medicine. 30 (Supplement S1), 186-7. 

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