S408 Poster Session 2

National Diagnostic Network (NDN) - which provides diagnostic and health care facilities (including health and nutrition education) through 9 Out-Patient Centers and a Central Laboratory. The present study has investigated the functional and financial performance of NDN during the last 3.5 yrs from the records analyzed for the time periods upto end of ‘97, ‘98 and ‘99. The data show that the number of registered patients almost doubled every year (4649.10752 and 19543 in the consecutive years) and the total visits increased in almost the same proportion (79195, 174885 and 282858). This happened in spite of a partial restriction on the extent of the free services given to diabetes care from July 1998 (aimed for more self-sustenance) With an almost steady capital investment (cumulative value mUS$ 1.43, 1.46 and 1.48 in the respective years) the health care was provided to such an increasing number of patients at a recurrent cost mUS$ 0.77, 1.25 and 1.85. The corresponding cash inflows to the Project (through selling services to nondiabetics and general health care services to diabetics) were mUS$O.36,0.78 and 1.42 which show a steep increase in the recovery rate (47% 62% and 77%). Adding the cost price of free services the% recovery rates became 61, 84 and 99 respectively. The findings show that providing quality health care to diabetic patients is possible through a self-sustaining approach with a modest investment.

P1582 Global Variation in Diabetes Care Practices in Type 1 Diabetes of 5-14 Years Duration. Prelimhmry Results from the DIACOMP Sub-Project of the WHO DIAMOND Study DIACOMP INVESTIGATORS. DIACOMP Coordinating Center. University of Pittsburgh, Pittsburgh. PA, United States of America

Previous international studies (e.g. Diabetes Epidemiology Research Inter- national) have shown a geographic variation in mortality among patients with ‘Qpe 1 diabetes, however, the underlying reasons for these differ- ences is unclear. To investigate this further, the WHO DIAMOND group initiated a sub-project (DIACOMP) to determine complication prevalence and variation in diabetes care practices across the world using standard- ized questionnaire data from participating DIAMOND registries and four additional non-diamond populations. In order to be eligible for this study, participants had to be diagnosed before age 15 years, between January 2, 1971 and June 30, 1994. Data presented are for those with duration of 5-14 years representing 1237 subjects (i.e. the 60% of eligible subjects whose data has been entered) from 17 centers in 14 countries interviewed between March 1996 and December 1999. Results are presented by geographic region, which had comparable mean age (17.5 years) and duration (9.2 years). The frequency of physician contact at least once in the last year, for diabetes care ranged from 72% in the Mediterranean to 100% in Western Europe, however the mean number of such visits in the last year ranged from 3.9 in Australia to 8.8 in Asia (Japan and China). Self-monitoring of blood glucose at least weekly ranged from 45% in the Caribbean (Cuba and Puerto Rico) to 97% in Western Europe and the Mediterranean. Intensive insulin therapy (~2 shots/day) was least frequently reported in North America (11%) and most often in the Mediterranean (99%). Mean number of shots/day likewise ranged from a high in Central Europe (Romania, Lithuania, Slovakia) and the Mediterranean of 3.8 to a low in North America of 2.1. Insulin dose/kg body weight was lowest, however, in Central Europe (0.84) and highest in Australia and Western Europe (1.1). Smoking was least often reported in Asia (9.7%) and most frequent in Australia (28%). These wide variations in diabetes care practices will be related to the prevalence of complications data also collected.

Pm3 Global Variation in Diabetes Care Practices in l)pe 1 Diabetes of 15-24 Years Duration. Preliminary Results from the DIACOMP Sub-Project of the WHO DIAMOND Study DIACOMP INVESTIGATORS. DIACOMP Coordinating Center, University of Pittsburgh, Pittsburgh, PA, United States of America

Previous international studies (e.g. Diabetes Epidemiology Research Inter- national) have shown a geographic variation in mortality in patients with Type 1 diabetes, however, the underlying reasons for these differences are unclear. To investigate this further, the WHO DIAMOND group initiated a sub-project to determine complication prevalence and variation in diabetes care practices across the world using standardized questionnaire data, back translated from the native language. As DIAMOND registry populations are of short duration, non-DIAMOND centers that were representative and had patients with longer diabetes duration were also enlisted. In order to be eligible for DIACOMP, participants had to be diagnosed before age 15 years, between January 2, 1971 and June 30, 1994. Data presented here are for the longer duration group (15-24 years) representing 703 subjects (i.e. the 34% of eligible cases whose data has been entered as of 3/00) from 8 centers in 8 countries surveyed between March 1996 and December 1999. Results are presented by geographic region which all had comparable mean age (28.9 years) and duration (20.1 years). Physician contact for diabetes care in the last year at least once varied from a low of 84% in the Mediterranean (Libya and Israel) to 100% in Asia (Japan) and South America. Mean number of such visits per year varied from 12 in Asia to 1.7 in Western Europe. The Caribbean reported the lowest frequency of at least weekly self-monitoring of blood glucose (26%) and intensive (>2shots/day) insulin therapy (34%), which was highest in Western Europe (99%). Mean insulin doseikg body weight was lowest in North America (0.72). Australia reported the highest ever-smoking rate (48%). These results will be related to the prevalence of complications data also collected.

Pm4 Seeking Ways To Improve Diabetes Care M. YIANNOUTSOS, PJ. Dixon, H. Snell. Diabetes Lifestyle Centre, Palmerston North, New Zealand

MidCentral Health’s Diabetes Lifestyle Centre (DLC) is undertaking a retrospective clinical audit to assess ways of improving the care in hospital of people with diabetes. The audit initiated by Dr Paul Dixon and the DLC aimed to find out how well people with diabetes were managed in hospital and what follow up was initiated for discharge. A random selection of 1000 case notes of medical and surgical in-patients at Palmerston North Hospital over the last year, aged between 15 years and 80 years old. The audit involved reviewing all aspects of the patients care, looking at how they were managed, if they were known to have diabetes prior to admission and how they were managed if they were newly diagnosed in hospital. The information was entered onto a database so comparisons could be made. Through data collected we found improvements could be made in nursing and medical documentation, discharge planning, follow up by the primary care giver and early referral to the DLC resulting in preventing readmissions and improved outcomes for people with diabetes.