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L'epidemiologia per la sanità pubblica
Istituto Superiore di Sanità
Epidemiologia per la sanità pubblica - ISS

The QUADRI Study

In 2004, the Istituto Superiore di Sanità coordinated the epidemiological study known as “QUADRI” (“Quality of Care for Diabetics in Italian Regions”), with the objective of assessing the quality and means of providing care, as perceived by persons with diabetes.


Care for persons with diabetes

  • A sample of 3,426 persons (58% men) were interviewed; the median age was 57 years, and 41% of the sample had fewer than 7 years of education.
  • Of the participants, 30% suffered from at least one complication, the most frequent of which was diabetic retinopathy (19%), followed by ischemic heart disease (13%). About 1 out of 5 participants had been hospitalised in the year preceding the interview.
  • Of the participants, 54% were aware of having hypertension, yet 14% of them were not undergoing therapy. Forty-four percent reported high cholesterol, yet 26% were not undergoing specific therapy.
  • At the time of diagnosis, 34% of the participants smoked; at the time of the interview, 25% still smoked, despite the fact that nearly all of them had been advised to quit.
  • Of the participants, 72% were overweight; 82% of them had been advised to lose weight, yet only half were attempting to do so (through diet, physical activity, and pharmaceuticals).
  • For most of the interviewed persons (64%), the main provider of care was the diabetes centre. The most common therapy was oral anti-diabetics alone (61%), whereas 26% of the persons used insulin or insulin plus oral anti-diabetics.
  • Only 49% of the participants had undergone a thorough examination by a general practitioner or a diabetes specialist in the previous six months; 59% had undergone an eye examination in the previous year, and 42% had received the influenza vaccine.
  • In the 4 months prior to the interview, glycosylated hemoglobin had been performed for 66% of the persons who had heard of the test (67% of the sample).
  • Of the persons undergoing insulin treatment, 63% performed self-monitoring of glycaemia at various times during the day.
  • Among the persons with a cardiovascular risk, only 15% used acetylsalicylic acid as primary prevention.
  • Nearly all of the persons interviewed (91-92%) were satisfied with the attitudes of healthcare workers.
  • Regarding the overall organisation of services, more than 80% of the persons were satisfied.


Despite some limitations, this study has contributed to increasing the knowledge on the various aspects of the care provided to persons with diabetes. The results indicate that the quality of the care provided is far from optimal. In Italy, as in other Western countries, there has been an increasingly heated debate over the ability of the healthcare system to reorganise its model of healthcare in the foreseeable future, so as to take into account the demand for care that is changing in terms of both quantity and quality and thus to adapt the facilities and services to the population’s true needs.

The need for integration and coordination in the management of care has led to the development of new care models which, in very general terms, can be defined as “disease management”. These approaches share the characteristics of being organised, integrated, proactive, and people-oriented, and at the centre of the system is an informed patient who has been educated to play an active role in managing his/her disease.


Download the ISTISAN report (pdf 3 Mb) with the definitive results of the study.