The effect on patient outcomes remained less clear as these were rarely assessed .
Arrangements for follow-up ( organisational intervention ) also showed a favourable effect on process outcomes .
Multiple interventions in which patient education was added or in which the role of the nurse was enhanced also reported favourable effects on patients ' health outcomes .
REVIEW ER 'S CONCLUSIONS Multifaceted professional interventions can enhance the performance of health professionals in managing patients with diabetes .
Organisational interventions that improve regular prompted recall and review of patients ( central computerised tracking systems or nurses who regularly contact the patient ) can also improve diabetes management .
The addition of patient-oriented interventions can lead to improved patient health outcomes .
BACKGROUND Diabetes is a common chronic disease that is increasingly managed in primary care .
Different systems have been proposed to manage diabetes care .
Rising incidence of insulin dependent diabetes in children aged under 5 years in the Oxford region: time trend analysis
Abstract Objectives : To monitor incidence of  insulin dependent diabetes in children in Oxford health region since 1985 , and to look for any evidence of disproportionate increase in children aged under 5 . Design : Primary ascertainment of cases of childhood diabetes was by prospect i ve registration of all patients with insulin dependent diabetes diagnosed before age 15 years between 1985 and 1996 and resident in Oxford region at time of diagnosis . This was supplemented by examination of central ised hospital discharge records and death certificates . Secondary case ascertainment was by postal surveys of general practitioners in 1987 and 1996 . Setting : Area formerly administered by Oxford Regional Health Authority . Subjects : 1037 children presenting with insulin dependent diabetes under age of 15 years . Main outcome measures : Incidence of insulin dependent diabetes in children aged 0 - 4 , 5 - 9 , and 10 - 14 years during 1985 - 95 . Results : Overall incidence of diabetes in children aged 0 - 15 was 18.6 cases/100 000/year and showed an annual increase of 4 % from 1985 to 1996 . This was mainly due to a rapid increase in children aged 0 - 4 years , in whom there was an annual increase of 11 % ( 95 % confidence interval 6 % to 15 % , P<0.0001 ) , while the annual increase in those aged 5 - 9 was 4 % ( 0 to 7 % , P=0.05 ) and in those aged 10 - 14 was 1 % ( −2 % to 4 % , P=0.55 ) . Conclusions : Incidence of insulin dependent diabetes  in children aged under 5 years has risen markedly in the Oxford region over the past decade . The cause of the increase is unknown , but environmental influences encountered before birth or in early postnatal life are likely to be responsible . Key messages The incidence of childhood diabetes has increased in Europe and many other parts of the world over the past 20 - 30 years In the Oxford region we found that the incidence of childhood insulin dependent diabetes increased by 4 % per year during 1985 - 95 Most of this increase was due to an increase of 11 % a year in children aged under 5 years , in whom incidence doubled over the study period Environmental factors encountered very early in life are likely to have been responsible for this increase , but the nature of such factors is unknown Attempts at preventing disease should be directed towards intrauterine or early postnatal
The effect on patient outcomes remained less clear as these were rarely assessed .
Arrangements for follow-up ( organisational intervention ) also showed a favourable effect on process outcomes .
Multiple interventions in which patient education was added or in which the role of the nurse was enhanced also reported favourable effects on patients ' health outcomes .
REVIEW ER 'S CONCLUSIONS Multifaceted professional interventions can enhance the performance of health professionals in managing patients with diabetes .
Organisational interventions that improve regular prompted recall and review of patients ( central computerised tracking systems or nurses who regularly contact the patient ) can also improve diabetes management .
The addition of patient-oriented interventions can lead to improved patient health outcomes .
BACKGROUND Diabetes is a common chronic disease that is increasingly managed in primary care .
Different systems have been proposed to manage diabetes care .