Recommendation   Type 2 Diabetes

Core messages

• Caring for people with diabetes requires systematic involvement of other, recognised (!) first-line providers: educators, (reference) nurses, dieticians, pharmacists, physiotherapists, psychologists, practice assistants.
• Structural cooperation with the second (and third) line of treatment is necessary, based on equality and complementarity and supported by validated care paths in which competitive concerns have no place.
• The exchange of information via the patient as conceived with the Diabetes Passport is essential in achieving this end, but is optimally accomplished in an automated manner enabling all care providers to review the patient’s file. 
• To increase the quality of care, a local diabetes bank should be developed to provide the GPs of the region with quality feedback.
• GPs and other physicians should develop the necessary communication skills to manage chronic patient care. In chronic care situations, special attention should be devoted to developing personal goals and voicing and discussing treatment compliance problems.
• The GP must be structurally supported in order to be able to assume his role as care coordinator. This requires mandatory registration of all diabetes patients in a GMD [Dutch acronym for Globaal Medisch Dossier, Global Medical File] at a GP’s office of their choice.
• Caring for people with diabetes in general practice requires compensation that is in proportion to the duration and complexity of the care process. Such compensation should not invite short and frequent doctor/patient contacts.
• Every GP should be able to access quickly and easily available (free) evidence-based information (such as recommendations, Minerva etc.) in order to be able to perform objective management of diabetes patients.
• Patients should be able to gain temporary access to a glucose meter, a prick pen and test strips whenever necessary, as well as in the event of illness or insufficient therapeutic response. Patients on insulin (even if only one injection) should be able to have permanent access to supplies.
• In addition, patients should be able to get access to a limited number of test strips to perform selfmonitoring over a short period of time.