Out-patient care of diabetics was analysed for the year 1988 from data available through the AOK Health Insurance at Dortmund, Germany, using a representative sample of 368 diabetics (124 men, 244 women; mean age 66.9 years). Compared with a group of nondiabetics (n = 1104), matched for age and sex, the diabetics had more contacts with their medical practitioner (36.3 vs 24.9; P < 0.001), more prescriptions (43.3 vs 26.1; P < 0.001) and more overall medical attention (77.6 vs 51.3; P < 0.001). Blood sugar measurements were obtained in 90.5% of the diabetics, but HbA1 was measured in only 8.2%. Only 7.1% of diabetics were given test strips for self-monitoring of urinary and blood sugar levels. Fundoscopic examination had been undertaken in 18.5% of diabetics. Measurements of total cholesterol, triglyceride and creatinine concentrations and recordings of the ECG were done in about half of the diabetics. Out-patient diagnostic tests for cardiovascular diseases were performed in fewer than 2% of both the diabetic and the control groups. These data make it clear that the out-patient care of diabetics with respect to metabolic control and monitoring of diabetes-related disease urgently requires improvement.
