Disease Management Programs for Type 2 Diabetes in Germany

Abstract

The observed beneficial trends with respect to mortality and survival time, as well as improvements in process parameters, indicate that DMPs can, in fact, improve the care of patients with diabetes. Further evaluation is needed, because some changes in outcome parameters (an important indicator of the quality of care) may only be observable over a longer period of time.

What should governments be doing to prevent diabetes throughout the life course?

“…• Set minimum standards for break times and outdoor equipment to increase physical activity levels [52] • Include a health subject called 'health' in (pre-) schools and continuously qualify the teachers [38] • Provide drinking water and low-cost/ free-of-charge healthy food [53] • Cooperate with local sports clubs in designing break time activities, physical activity lessons and afternoon care [54] • Improve access to eHealth devices for diabetes self-management [55] • Restrict advertisement of unhealthy food choices across the media spectrum [41,56] • Publicity intervention to increase awareness to promote earlier diagnosis of type 1 diabetes [57] • Implement binding quality standards and healthy food procurement for the catering tenders in (pre-)schools [41] • Restrict the advertisement of unhealthy products [41,54,56] • Implement fat and/or sugar taxes [56] and/or set smaller prices for healthier beverages (especially at school) [41] Working-age population • Implement the structured, evidence-based curricula like the Diabetes Prevention Program (DPP) [58] and monitor their effectiveness in different settings and target groups [59] • Include community awareness campaigning in national chronic disease and/or diabetes plans [61] • Offer (tax) subvention for companies who actively support their employees' health and support companies to develop and implement measures of operational health management [58] • Improve access to eHealth devices for diabetes self-management [55] • Include workplace interventions for individuals at risk [61] • Offer subvention of healthy food procurement for companies [59] Elderly • Develop structured care programmes, and increase frequency of educational sessions [62,63] • Continuously monitor the enrolment rates in interventions and effectiveness for specific subgroups of the population [64] • Strengthen eHealth literacy to increase access to digital health information [65] • Reduce or eliminate out-of-pocket costs for diabetes medication and self-monitoring supplies [66] The Interventions should, according to the authors, include regular counselling on dietary behaviour, such as the composition of a healthy meal (not more than 75...…”

“…diseasespecific complication rates), and to improve the general care process and overall quality of life. A systematic review evaluating the effectiveness of disease-management programmes in Germany uncovered benefits in terms of mortality rates, survival time and process parameters (such as doctor-patient relationships, and participation rates in diabetes education) [62]. In addition to improved care coordination, education in the form of training courses is still a promising way of receiving self-care information much needed to cope with the daily burden of disease [63].…”

Selective enrollment in Disease Management Programs for coronary heart disease in Germany – An analysis based on cross-sectional survey and administrative claims data

“…Secondly, selective enrollment might influence the results of DMP evaluation [4] and studies trying to evaluate DMPs face the difficulty of selecting suitable control groups [5]. This becomes more important when considering that 14 years after the introduction of DMPs, methodologically solid evidence on their effectiveness is still limited [6]. The mandatory program evaluation according to clause 137f, paragraph 4 in Book Five of Germany’s Social Security Code (SGB V), includes DMP enrollees only, thus a control group is missing and inferences on the effectiveness of DMPs cannot be made.…”

“…Most studies on DMPs focused on the DMP for type 2 diabetes (DM2) [4, 6, 9, 14–17]. Little is known about the effects of selective enrollment within the DMP-CHD.…”

Low annual frequency of HbA1c testing in people with Type 2 diabetes in primary care practices in Germany

“…Although the clinical practice recommendations of the German Diabetes Association do not include a minimum number of HbA 1c tests per year, German Disease Management Programs (DMPs) require that HbA 1c be tested at least twice per year, and that four tests per year be carried out to ensure optimal diabetes management . These guidelines play a major role in Type 2 diabetes management in Germany, as the vast majority of people with Type 2 diabetes are enrolled in DMPs .…”