proliferative diabetic retinopathy | Figure 1

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Proliferative Diabetic Retinopathy

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Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes

Key messages
‐ Quality improvement programmes can improve diabetes care, especially when multiple strategies are used in combination.
‐ Strategies used in these programmes that lead to the largest improvements in key outcomes in people with diabetes are: case management, team changes, patient education and promotion of self‐management.

What did we find?
We found 553 studies with 412,161 people with diabetes. Studies took place in countries around the world with most being conducted in the USA (231) and in medical settings. Most studies (367) involved people with type 2 diabetes. Half of the study participants were female. The average age of participants was 57 years. Most studies lasted 12 months.

Studies usually used multiple quality improvement strategies together. Most commonly, studies featured three quality improvement strategies.

Main results
Overall, case management, team changes, patient education and promotion of self‐management appeared to be the most effective quality improvement strategies for diabetes care. When considering three‐strategy combinations, the combination of clinician education, promotion of self‐management and patient reminders may lead to the most improvement in blood sugar control in people who begin with lower HbA1c. Whereas the combination of case management, patient education and electronic patient registries may lead to the largest improvement in blood sugar control for people who begin with higher HbA1c. For blood pressure, people who have lower systolic blood pressure may see the most improvement with the combination of patient education, team changes and promotion of self‐management. People who have higher systolic blood pressure may improve the most with the combination of case management, team changes and promotion of self‐management. For cholesterol, we found that team changes, patient education and case management may lead to the most improvement in people who already have lower low‐density lipoprotein levels. For those who have higher levels of low‐density lipoprotein, team changes, case management and clinician reminders may lead to the largest improvement. Patient education, patient reminders and team changes may lead to an increase in retinopathy screening rates.

Uncontrolled Diabetes

This is an ulcer at the bottom of right foot (diabetic ulcer)

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A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days.