Do diabetes guidelines influence the content of referral letters by general practitioners to a diabetes specialist clinic?

OBJECTIVE

To ascertain whether local guidelines for diabetes management influence the content of GP referral letters to a diabetes specialist clinic.

DESIGN

Retrospective survey of hospital outpatient clinic casenotes and GP referral letters of patients with Type 2 diabetes.

METHODS

An examination was made of 200 GP referral letters submitted before (Set 1), and 200 GP referral letters submitted after (Set 2), local guidelines on the management of adult diabetes had been issued to GPs in Lothian. The frequency with which micro- and macrovascular complications of diabetes were documented in the GP referral letters was compared with the frequency ascertained at the first attendance to the specialist clinic.

MAIN RESULTS

Following the distribution of diabetes guidelines, no significant change was noted in the frequency with which specific conditions were documented in GP referral letters (Set 1 vs Set 2): hypertension (72% vs 79%); cerebrovascular disease (89% vs 80%); ischaemic heart disease (74% vs 79%); peripheral vascular disease (42% vs 64%); cataract (35% vs 44%); retinopathy (18% vs 40%) and peripheral neuropathy (17% vs 12%). At the diabetic clinic many unreported diabetic complications were found in patients who had been referred after varying periods of treatment in primary care. However, the guidelines did appear to have encouraged the active treatment of hyperglycaemia by GPs before referral of newly-diagnosed diabetic patients.

CONCLUSIONS

Diabetes guidelines per se appeared to have very little effect on increasing the information provided in GP referral letters on relevant medical problems and did not appear to have influenced screening for complications in patients with Type 2 diabetes by GPs before specialist referral. Methods other than the issue of written guidelines are required to achieve optimal assessment of diabetic patients in the community.