Introduction: Diabetes in Africa has been described as a pandemic, with the prevalence in South Africa estimated at 4.5% of the population. Despite clear national guidelines from the Society of Endocrinology, Metabolism and Diabetes of South Africa, an unpublished quality improvement cycle in 2007 has shown poor patient knowledge with associated uncontrolled glycaemic and hypertensive control in diabetic patients in a district health system. The purpose of the study was to identify possible reasons for this and to find solutions for improving diabetic care within the Wesbank/ Ilingu Lethu suburb of Malmesbury, Western Cape. Methods: A cooperative inquiry group was established, consisting of primary health care providers at a district hospital and a primary health care clinic. The inquiry completed several cycles of action-reflection over a period of eight months, and included training in diabetic related topics and critical reflection techniques. At the end of the inquiry consensus was reached on key findings by group and learning within the group. Findings: Consensus was expressed in two key findings. The group identified and prioritized continuity of care and diabetic education key areas where diabetic care could be improved in the research population. The first was addressed by initiating diabetic registries, establishment of a regular diabetic clinic, implementation of a diabetic schedule within the medical records and the forming of a diabetic team that could support continuity of relationships, clinical management and organisation of care between both facilities. The diabetic team involved non-governmental organizations, private health providers and the community to increase awareness and develop capacity to improve diabetic care. The other finding confirmed diabetic education as a critical area in diabetic self management. The diabetic team initiated a diabetic community forum for educational and informative group activities. There was also continued professional development with education sessions within the cooperative inquiry group themselves. Conclusions: Improving diabetic care through continuity of care and education is well supported in known evidence based literature. The challenge is to translate/ transfer the available knowledge and render it operational and clinical in any health setting. The co-operative inquiry process was a valuable tool to identify, prioritized and addresses unique challenges for improving diabetic care in our specific context.

Managing medical care for patients with diabetes mellitus requires a comprehensive approach that includes empowering the patient to be an active participant in the management of their disease as lifestyle management, in addition to medical therapy, is a crucial component in the care of the diabetic patient. The objective of this project was to determine if implementing diabetic care cards in a family medicine residency clinic would increase patient engagement with their care in the form of knowledge concerning A1C values and subjectively feeling in control of their diabetes. The initial phase of the project involved providing diabetic patients a brief anonymous survey concerning their A1C and asking if they felt in control of their diabetes; these surveys were collected for several months. The next phase consisted of an educational lecture during formal resident physician didactic time where diabetic guidelines were discussed, diabetic care cards were introduced, and the resident physicians were encouraged to utilize the cards with their diabetic patients. After several months of implementation of the diabetic care cards in the clinic, the same anonymous survey was repeated with diabetic patients. A total of 93 anonymous patient surveys were collected prior to formal resident physician education concerning diabetic care cards and a total of 40 anonymous surveys were collected after formal resident physician education. The data from the pre and post educational surveys were then reviewed and compared and data was analyzed. Overall, A1C values did not significantly differ between the pre- and post-survey groups. Although there was a slightly higher percentage of patients who reported knowing their A1C level after the diabetic card implementation, this was not statistically significant and there was not a statistically significant difference in the percentage of patients that felt in control of their diabetes between survey groups. It was found that higher A1c values were associated with patients feeling less in control of their diabetes. A limitation of this study was realized with the methodology; it is not known if every patient who completed a survey also directly encountered the diabetic care card. The study yielded some valuable insight into patient perspective of diabetes control. It was found that an A1C less than or equal to 7%, which is the A1C goal for most diabetic patients, did not necessarily correlate with diabetic patients feeling in control of their diabetes. It was felt that this indicated that there is room for improvement in patient education concerning A1C goal. It also revealed a need for further investigation of the factors that influence whether a patient feels they are in control of their diabetes.

Introduction: Type 1 diabetes is a chronic disease that affects the individual in everyday life. The diabetes team sets the treatment goals together with the patient aiming for a good quality of life and to prevent complications. The diabetes nurse should include in-depth knowledge of the daily life of people with diabetes, and have respect for the individual's choices and life situation. Aim: To describe how people with type 1 diabetes experience the support from the diabetes nurse. Method: A qualitative content analysis with an inductive approach has been used. A secondary analysis including semi-structured interviews with 15 adults (> 18 years) with type 1 diabetes was conducted. Result: The result was summarized with an overall theme "At the clinic - experience of the support offered" describes how people experience the support from their diabetes nurse. The theme constituted three categories "Access to the diabetes nurse", "The diabetes nurse - a source of information and knowledge that might need to be complemented with the support from other professionals" and,"Mutual trust - the patient's experience of the district nurse as a discussion partner and support". Conclusion: The results showed that the accessibility to diabetes nurses was experienced as good. It was simple and easy to make contact. The diabetes nurses were experienced to be engaged and provide good support to the patients. A good dialogue with the diabetes nurse and commitment from the diabetes nurse were mentioned as important factors that made the visits to be experienced as good and important. There were requests for greater access and expanded opportunities for help from counselors, as well as an increased focus on how the person is feeling. / Introduktion: Diabetes typ 1 är en kronisk sjukdom som påverkar personen i vardagen. Diabetesteamet sätter upp mål tillsammans med patienten om dennes behandling för att få en bra livskvalitet och motverka komplikationer. Diabetessjuksköterskan bör bland annat ha fördjupade kunskaper om det dagliga livet för personer med diabetes samt ha respekt för den enskilde individens val och livssituation. Syfte: Att beskriva hur personer med diabetes typ 1 upplever stödet från diabetessjuksköterskan. Metod: En kvalitativ innehållsanalys med en induktiv ansats har används. En sekundäranalys har gjorts där semistrukturerade intervjuer med 15 vuxna (>18 år) med diabetes typ 1 inkluderats. Resultat: Resultatet sammanfattades med ett övergripande tema "Att komma till mottagningen - upplevelsen av stödet i den vård som erbjuds" som handlar om hur personer upplever stödet från sin diabetessjuksköterska. Temat bestod av tre kategorier "Tillgänglighet till diabetessjuksköterskan ", "Diabetessjuksköterskan - en källa till information och kunskap som kan behöva kompletteras med andra yrkesgrupper" och "Ett ömsesidigt förtroende – patientens upplevelse av diabetessjuksköterskan som diskussionspartner och få stöd". Konklusion: Resultatet visade att tillgängligheten till diabetessjuksköterskorna upplevdes god. Det var enkelt och lätt att ta kontakt. Diabetessjuksköterskorna upplevdes vara engagerade och ge ett bra stöd till patienterna. En bra dialog med diabetessjuksköterskan och engagemang från diabetessjuksköterskan nämndes som viktiga faktorer som gjorde att besöken kändes bra och betydelsefulla. Det framkom önskemål om ökad tillgänglighet och utökade möjligheter till hjälp från kuratorer, samt ett ökat fokus på hur personen mår.

Aim To determine the impact on clinical outcomes of specialist diabetes clinics compared with routine primary care clinics. Methods Observational study measuring clinical performance (process/outcome measures) in the primary care sector. A cohort of patients attending specialist diabetes clinics was compared with a control cohort of patients attending routine primary care clinics. Results Patients seen in specialist diabetes clinics had a significantly higher HbA1c than patients in routine primary care clinics (mean difference 0.58%; P < 0.001) but there was no significant difference in rate of improvement with visits compared with primary care clinics. In contrast, patients seen in the routine primary care clinics had significantly higher cholesterol levels (mean difference 0.24 mmol/l; P < 0.001) compared with patients in specialist diabetes clinics and their improvement was significantly greater over time (mean difference 0.14 mmol/l per visit compared with 0.10 mmol/l; P < 0.006). Patients in routine primary care clinics also had significantly higher diastolic blood pressure (mean difference 1.6 mmHg; P < 0.007) but there was no difference in improvement with time compared with specialist diabetes clinics. Uptake of podiatry and retinal screening was significantly lower in patients attending routine primary care clinics, but this difference disappeared with time, with significant increases in uptake in the primary care clinic group. Weight increased in both groups significantly with time, but more so in the specialist clinic patients (mean increase 0.18 kg per visit more compared with routine clinic primary care patients; P < 0.001). Conclusions This study provides evidence that the provision of primary care services for patients with diabetes, whether traditional general practitioner clinics or diabetes clinics run by general practitioners with special interests, is effective in reducing HbA1c, cholesterol and blood pressure. However, the same provision of care was unable to prevent increasing weight or creatinine over time. No evidence was found that patients in specialist clinics do better than patients in routine primary care clinics.

Bakgrund: Diabetes mellitus typ-1 är en autoimmun sjukdom som varje år kräver människors liv. Att undersöka unga vuxna personer med typ-1 diabetes erfarenheter av diabetesvården kan bidra till att identifiera problemområden som kan förbättras, samt stärka relevansen för redan insatta behandlingsmetoder.  Syfte: Studiens avsikt var att beskriva unga vuxna personer med typ-1 diabetes erfarenheter av diabetesvården. Metod: En allmän litteraturöversikt enligt Polit och Becks niostegsmodell. Elva artiklar inhämtades från databaserna PubMed och CINAHL. Data analyserades med kvalitativ innehållsanalysmetod av Graneheim och Lundman.  Resultat: I studien identifierades två kategorier och fyra underkategorier. Personen i fokus utgjorde en kategori med underkategorierna: att klandras och att inte få tillräckligt med stöd. Tillgänglighet utgjorde den andra kategorin med underkategorierna: att ställas inför förändring och behov av kontinuerlig samverkan. Resultatet visar att erfarenheter talar för en undermålig diabetesvård.  Slutsats: Diabetes typ-1 är en omställning i livet som innebär stora påfrestningar och krav på patienten, men också för vården i hantering av patienten i förhållande till behandlingsstrategier och den personcentrerade vården. Det krävs mer forskning för att få ett bredare perspektiv på den individuella patienten i förhållande till den skildring som ska förändra vårdstrategier på en global nivå. / Background: Diabetes mellitus type-1 is an autoimmune disease that claim lives every year. Investigating the experiences of diabetes care, can identify problem areas and improve them to strengthen already implemented treatment methods.  Aim: The purpose of the study was to describe the experiences of young adults with type-1 diabetes of diabetes care. Method: A general literature review according to Polit and Beck's nine-step model. Eleven articles were retrieved from the databases PubMed and CINAHL. The data was analyzed using the qualitative content analysis method by Graneheim and Lundman. Results: In the study two categories and four subcategories were identified. The person in focus constituted the first category, with subcategories: to be blamed and not receiving enough support. Availability formed the second category with the subcategories: to be faced with change and need for continuous collaboration. The results speak for a substandard diabetes care. Conclusions: Diabetes type-1 entails great stress and demands on patients and the healthcare system in relation to treatment strategies and the person-centered care. Further research is needed to gain a broader perspective in relation to the portrayal that will change care strategies on a global level.