The JEVIN trial: A population-based survey on the quality of diabetes care in Germany: 1994/1995 compared to 1989/1990

Schiel, Ralf; Müller, Ulrich A.; Sprott, Haiko; Schmelzer, A.; Mertes, Bernardo; Hunger-Dathe, Wilgard; Ross, Iain

doi:10.1007/s001250050831

Cited by 58 publications

(39 citation statements)

References 40 publications

(45 reference statements)

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“…The annual incidence of DKA among subjects with type 1 diabetes is between 1% and 5% in European and American series [6][7][8][9][10] and this incidence appears to have remained relatively constant over the last decade in Western countries. Episodes of DKA are more common in younger than older subjects and are twice as common in females than males.…”

Section: Epidemiologymentioning

confidence: 99%

Hyperglycaemic crises and lactic acidosis in diabetes mellitus

English

Williams

2004

Postgraduate Medical Journal

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Diabetic ketoacidosis, hyperglycaemic hyperosmolar state, and lactic acidosis represent three of the most serious acute complications of diabetes. There have been some advances in our understanding of the pathogenesis of these conditions over the last three decades, together with more uniform agreement on their treatment and innovations in technology. Accordingly their incidence, morbidity, and mortality are decreasing, but at rates that fall short of our aspirations. Hyperglycaemic crises in particular remain an important cause of morbidity and mortality in diabetic populations around the world. In this article, understanding of these conditions and advances in their management, and the available guidelines for their treatment, are reviewed. As far as is possible, the recommendations are based on clear published evidence; failing that, what is considered to be a common sense synthesis of consensus guidelines and recommendations is provided.

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Section: Epidemiologymentioning

confidence: 99%

Hyperglycaemic crises and lactic acidosis in diabetes mellitus

English

Williams

2004

Postgraduate Medical Journal

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“…Little prospective research is available that examines the influence of diabetes specialist care on complication outcomes. In a study by Schiel et al (24), decentralization of diabetes care from specialist centers to general practice demonstrated an increase in rates of proliferative retinopathy and worse glycemic control in people with type 1 diabetes when comparing nonspecialized care in the decentralized system to centralized diabetes care. This study, however, did not follow the same cohort for the two time periods.…”

Section: Incidence Of Complicationsmentioning

confidence: 99%

“…Other studies examining effects of specialist care have not used standardized methods to classify care, as was done in this study. Additionally, studies examining this research question have been cross-sectional in nature (3,4,24,28,30) or conducted in clinic populations (5,9,10,31) with few examining complication outcomes. Studies examining the interrelationship between types of care received, socioeconomic factors, and complication outcomes appear to be absent in the literature.…”

Section: Incidence Of Complicationsmentioning

confidence: 99%

Influence of Health Care Providers on the Development of Diabetes Complications

et al. 2002

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OBJECTIVE -To quantify total diabetes care received (generalist or specialist) from diagnosis onward and its association with the incidence of diabetes complications in a representative cohort of patients with type 1 diabetes. RESEARCH DESIGN AND METHODS-A total of 429 subjects from the Pittsburgh Epidemiology of Diabetes Complications Study, a prospective follow-up study of childhoodonset type 1 diabetic subjects first seen between 1986 and 1988 (mean age 28 years, mean duration 19 years), followed biennially for up to 10 years were studied. Specialist care was defined as care received from a board-certified endocrinologist, diabetologist, or diabetes clinic and quantified as the percent of diabetes duration spent in specialist care.RESULTS -There was a significant trend for a higher incidence of neuropathy, overt nephropathy, and coronary artery disease with lower use of specialist care. Multivariate analyses controlling for diabetes duration, demographic characteristics, health care practices, and physiological risk factors demonstrated that higher past use of specialist care was found to be significantly protective against the development of overt nephropathy (risk ratio 0.43, 95% CI 0.21-0.88) and neuropathy (0.54, 0.35-0.83) and weakly protective against coronary artery disease (0.65, 0.37-1.1).CONCLUSIONS -A higher proportion of diabetes duration spent in specialist care may result in delayed development of certain diabetes complications independent of other risk factors. This study thus supports the concept that the benefits of specialist care should be available to all patients with type 1 diabetes.

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“…Jena's St. Vincent Trial (JEVIN) Study from the former German Democratic Republic (East Germany) reported a significant worsening of glycemic control among type 1 diabetic patients after the decentralization of the health care system (5). In other European countries, intensive insulin therapy was successfully implemented in primary care after extensive inpatient education (6)(7)(8), and in the U.S., several initiatives with local quality-control procedures have shown significant beneficial effects on diabetes care (3,9).…”

mentioning

confidence: 99%

Targets and reality: a comparison of health care indicators in the U.S. (Pittsburgh Epidemiology of Diabetes Complications Study) and Hungary (DiabCare Hungary).

Tabák

Tamás

Zgibor³

et al. 2000

Diabetes Care

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OBJECTIVE -In the U.S., both primary care and specialist physicians share in the care of type 1 diabetic patients, often in an informal collaboration. In Hungary, however, type 1 diabetic patients are generally managed in special centralized diabetes units. These different treatment settings may lead to different health care practices and outcomes. To determine if this is true, diabetes care indicators and complications were compared across representative study populations from the 2 countries. RESEARCH DESIGN AND METHODS -The Pittsburgh Epidemiology of DiabetesComplications Study (EDC) is a prospective cohort of childhood-onset type 1 diabetic patients. DiabCare Hungary, a multicenter cross-sectional study, was developed for quality control purposes and provides a nationwide data set of diabetic patients. We identified 2 comparable populations (EDC, n = 416; DiabCare, n = 405) in terms of age (Ն14 years) and age at onset (Ͻ17 years).RESULTS -EDC patients were less likely to receive diabetes education (P Ͻ 0.0001), see an ophthalmologist (P Ͻ 0.0001), be treated by diabetologists (P Ͻ 0.0001), or perform selfmonitoring of blood glucose (P Ͻ 0.0001). They were more likely to use conservative insulin regimens (i.e., 1-2 injections/day, P Ͻ 0.0001) and have a higher glycated hemoglobin (P Ͻ 0.0001). DiabCare patients more often experienced severe hypoglycemia (P Ͻ 0.01) and had a lower prevalence of proliferative retinopathy (P Ͻ 0.0001), legal blindness (P Ͻ 0.05), and albuminuria (Ն30 mg/day, P Ͻ 0.01). No significant differences in macrovascular complications were seen, although rates were generally low.CONCLUSIONS -These data suggest that the 2 populations differ by their diabetes care practices, degree of glycemic control, and microvascular complication status.

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The JEVIN trial: A population-based survey on the quality of diabetes care in Germany: 1994/1995 compared to 1989/1990

Cited by 58 publications

References 40 publications

Hyperglycaemic crises and lactic acidosis in diabetes mellitus

Hyperglycaemic crises and lactic acidosis in diabetes mellitus

Influence of Health Care Providers on the Development of Diabetes Complications

Targets and reality: a comparison of health care indicators in the U.S. (Pittsburgh Epidemiology of Diabetes Complications Study) and Hungary (DiabCare Hungary).

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