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November 22, 1995

Quality of Outpatient Care: Diabetes

Author Affiliations

Oklahoma City, Okla

JAMA. 1995;274(20):1584. doi:10.1001/jama.1995.03530200020017

To the Editor.  —While the claims-based method for evaluating office-based quality was interesting,1I take issue with the extrapolation of the results in the accompanying Editorial.2 There is no evidence that regular measurement of glycosylated hemoglobin or cholesterol, let alone a specific frequency of measurements, will improve patient outcomes. Tight control of insulin-dependent diabetes has been shown to reduce complication rates, but this has not been demonstrated for non-insulin-dependent diabetes, the more common adult form. Perhaps the reason that the American Academy of Family Physicians has not released guidelines on the management of diabetes is the lack of a scientific basis for guidelines.Dr Leape's hypothetical patient asks, "If routine performance of these tests does in fact save lives and sight, then why aren't physicians required to perform them?" The more appropriate question may be this: If we don't know whether these tests save lives, why are physicians

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