Henrichs H R, Piwernetz K, Sönksen P H, Jährig D, Reach G, Fischer U
Diabetes Center Quakenbrück, Germany.
Diabete Metab. 1993;19(1 Pt 2):70-3.
The need for permanent, population-wide, improvement in metabolic care of diabetic patients is generally accepted. This paper highlights some related aspects which must be considered by any health care provider: (1) Monitoring metabolic or other variables in diabetic patients is an essential tool in routine metabolic care, where a "short feedback" between monitored data and medical or behavioral measures is permanently established by the patients themselves, the physicians, the nurses etc. (2) Quality insurance requires the closure of a "long feedback" between informations and interventions, such as conditions, tools, methods, used at the different levels of the care system, from the individual patient to a population scale. (3) Appropriate epidemiological studies are required to program and evaluate the effect of any activity aimed at insuring and maybe improving the quality of care of diabetic patients, especially if one considers the time required to reach "hard end-points" such as the evaluation of patient mortality or the outcome of children from diabetic mothers. (4) The knowledge of incidence and prevalence rates of diabetes and its complications, and of risk factors may stimulate the political and economical recognition of the importance of the disease by health care officials. (5) In this way, the medical recognition is also stimulated within the professional team responsible for the establishment of the "long feedback" of quality insurance at the level of a given method, of an individual patient or of a health care unit, and for the actual implementation of generally accepted knowledge, everywhere in routine care.
糖尿病患者代谢护理的永久性、全人群改善需求已得到普遍认可。本文重点介绍了任何医疗服务提供者都必须考虑的一些相关方面：（1）监测糖尿病患者的代谢或其他变量是常规代谢护理的一项基本工具，患者自身、医生、护士等会在监测数据与医疗或行为措施之间永久建立“短反馈”。（2）质量保障要求在信息与干预措施之间建立“长反馈”，这些干预措施包括在护理系统不同层面（从个体患者到人群规模）所使用的条件、工具、方法等。（3）需要进行适当的流行病学研究，以规划和评估任何旨在确保并可能改善糖尿病患者护理质量的活动的效果，特别是考虑到达到“硬终点”（如评估患者死亡率或糖尿病母亲所生子女的结局）所需的时间。（4）了解糖尿病及其并发症的发病率、患病率以及危险因素，可能会促使卫生保健官员从政治和经济层面认识到该疾病的重要性。（5）通过这种方式，在负责在特定方法、个体患者或卫生保健单位层面建立质量保障“长反馈”，以及在常规护理的各个地方实际应用普遍认可知识的专业团队内部，也会激发医学认知。
