Quality of Diabetes Care in Germany Improved from 2000 to 2007 to 2014, but Improvements Diminished since 2007. Evidence from the Population-Based KORA Studies

Abstract

ObjectiveLittle is known about the development of the quality of diabetes care in Germany. The aim of this study is to analyze time trends in patient self-management, physician-delivered care, medication, risk factor control, complications and quality of life from 2000 to 2014.MethodsAnalyses are based on data from individuals with type 2 diabetes of the population-based KORA S4 (1999–2001, n = 150), F4 (2006–2008, n = 203), FF4 (2013/14, n = 212) cohort study. Information on patient self-management, physician-delivered care, medication, risk factor control and quality of life were assessed in standardized questionnaires and examinations. The 10-year coronary heart disease (CHD) risk was calculated using the UKPDS risk engine. Time trends were analyzed using multivariable linear and logistic regression models adjusted for age, sex, education, diabetes duration, and history of cardiovascular disease.ResultsFrom 2000 to 2014 the proportion of participants with type 2 diabetes receiving oral antidiabetic/cardio-protective medication and of those reaching treatment goals for glycemic control (HbA1c<7%, 60% to 71%, p = 0.09), blood pressure (<140/80 mmHg, 25% to 69%, p<0.001) and LDL cholesterol (<2.6 mmol/l, 13% to 27%, p<0.001) increased significantly. However, improvements were generally smaller from 2007 to 2014 than from 2000 to 2007. Modeled 10-year CHD risk decreased from 30% in 2000 to 24% in 2007 to 19% in 2014 (p<0.01). From 2007 to 2014, the prevalence of microvascular complications decreased and quality of life increased, but no improvements were observed for the majority of indicators of self-management.ConclusionDespite improvements, medication and risk factor control has remained suboptimal. The flattening of improvements and deteriorations in quality of (self-) care since 2007 indicate that more effort is needed to improve quality of care and patient self-management. Due to selection or lead time bias an overestimation of quality of care improvements cannot be ruled out.

Associations between self-management behavior and sociodemographic and disease-related characteristics in elderly people with type 2 diabetes — New results from the population-based KORA studies in Germany

“…In Germany, medication adherence and control of relevant factors, such as blood glucose, blood pressure and lipids, have both significantly improved over the last decade. However, no progress were observed in the level of patients' SMB [16,17]. Here, besides sociodemographic factors like age and sex, research suggests that also changeable factors like emotional and practical support, as well as the occurrence of depressive symptoms, play an important role [18].…”

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

“…Few studies have investigated the frequency of HbA 1c testing in people with Type 2 diabetes in Germany. Recently, an analysis based on data from the KORA (Cooperative Health Research in the Augsburg Region) S4/F4/FF4 cohort study showed a significant increase in the reported annual HbA 1c checks in Southern Germany; they increased from 29% in 2000 to 53% in 2007 and 72% in 2014 . This increase was associated with a decrease in mean HbA 1c concentration from 53.99 mmol/mol (2000) to 51.58 mmol/mol (2007) and to 50.27 mmol/mol (2014).…”

Quality of care for type 2 diabetes mellitus in Tripoli Medical Center: a retrospective study of 628 patients

“…Despite the broadly distributed diabetes care guidelines, which give clear recommendations to the glycemic, blood pressure and lipid targets in diabetic patients, several studies have indicated that achievement of these targets is suboptimal [22][23][24][25].…”