Dr Alistair Emslie-Smith is a general practitioner based in Scotland, responsible for the day-to-day care of 300 patients with diabetes registered with his practice. He is also the lead clinician for the Tayside Diabetes Managed Clinical Network, which seeks to provide comprehensive, integrated diabetes care across primary and secondary care for all 13,000 patients with diabetes in the region.

Dr Emslie-Smith has been a member of the Tayside Diabetes Strategy Group since 1996, recently chairing its Re-design & Development Strategy Sub-Group. As a research fellow for the Diabetes Audit and Research in Tayside Scotland (DARTS) Project from 1997-2003, he has been actively involved in the development of a Web-based clinical communication and decision support IM&T tool (DARTS 2000, www.diabetes-healthnet.ac.uk), which underpins the Managed Clinical Network for diabetes care in his region. The Scottish Executive Health Department has recently adopted the DARTS 2000 System as the preferred system to support diabetes care nationally. He is a member of the User Group Executive of this National Diabetes IT Programme (SCI-DC).

He served on the Scottish Intercollegiate Guidelines Network (SIGN) Development Group on Prevention of Visual Impairment in Diabetic Patients 1999-2000 and on the Scottish Primary Care Collaborative Diabetes Reference Group, April 2003. He is interested in population-based epidemiology as well as various aspects of diabetes care, such as registers and clinical decision-support systems, the integration of primary and secondary care and barriers to achieving satisfactory outcomes.

For his particular patient population, the major issues surrounding patient management are the rising level of Type 2 diabetes and the need for increasingly intensive treatment and monitoring to achieve evidence-based goals. Dr Emslie-Smith thinks that polypharmacy is another issue in patient management, as is a lack of a systematic and comprehensive retinopathy screening system.

Dr Emslie-Smith believes that patient education is the key to success in diabetes care and that the greatest challenge is to find appropriate methods of communicating to patients at their level of understanding and to ensure that appropriate support and advice are easily accessible whenever they are needed.

With regard to current methods of diabetes care, Dr Emslie-Smith is concerned about the lack of cohesiveness and integration of services and the variation in approaches to diabetes care, particularly in primary care. The lack of adherence to often complex drug regimens is also, he believes, a major barrier to effective care. Finally, Dr Emslie-Smith feels that treatment strategies are often reactive, responding only when therapeutic targets fail, rather than proactive, aiming to ensure maintenance of tight control.