Setting and negotiating blood sugar and blood pressure targets with people with Type 2 diabetes in primary care: a cross sectional survey

Aims To investigate the provision of diabetes care, the frequency of practices setting targets for their diabetic population, the targets set and the frequency of targets being negotiated with people with diabetes. Methods Cross-sectional study using a survey of 123 general practices within four Primary Care Trusts in Nottingham UK. Results Eighty per-cent (99) of practices responded. Of these, 88 and 89%, respectively, had set glycosolated haemoglobin (HbA(1c)) and blood pressure targets for people with Type 2 diabetes. Twenty-five per-cent (24) of practices reported negotiating targets with almost all people with Type 2 diabetes for HbA(1c) and 31% (30) for blood pressure. In 46% (45) of practices, the annual diabetic review for some or all of the people with Type 2 diabetes was carried out by the practice nurse alone. In these practices, targets were negotiated with a smaller proportion of people than those where the doctor was involved in the annual review for both blood pressure 1.43 vs. 64% negotiated blood pressure targets with almost all or many people odds ratio (OR) 0.42 (95% CI 0.19, 0.96), P = 0.04] and HbA(1c) [39 vs. 60% negotiated HbA(1c) targets with almost all or many people, OR 0.41 (95% CI 0.18, 0.94), P = 0.03]. Conclusions Negotiating targets with people with Type 2 diabetes does not routinely occur in primary care. Targets are negotiated less often in practices where nurses undertake reviews alone and further work is needed to explore the reasons for this.