Verbesserungen in der Versorgung von Patienten mit Typ-2-Diabetes?

Abstract

To evaluate the quality of diabetes care, processes and outcomes of health care for type 2 diabetes were compared across three population-based surveys in Germany with cross-sectional and longitudinal perspectives. The surveys were conducted in the Augsburg region, southern Germany, in 1999-2001, 2003-2005, and 2006-2008 and included physical examinations, an interview, self-administered diabetes questionnaires, and laboratory tests. Quality indicators derived from guidelines for type 2 diabetes managed care programs in Germany served as the evaluation framework. Multiple regression models were used for analysis, adjusting for age, sex, education, diabetes duration, and cardiovascular comorbidity. Results show that medical examinations of eyes (61-71%) and feet (38-55%) and the use of antihypertensives, antiplatelet drugs, and lipid-lowering medications were reported more frequently over time. There was no increase in patient self-care behaviors or diabetes education. Blood pressure and cholesterol outcome targets were achieved more frequently over time. In conclusion, medical care and drug therapy of type 2 diabetes have improved; however clinical practice has failed to intensify patient participation and health behavior.

Changes in diabetes care indicators: findings from German National Health Interview and Examination Surveys 1997–1999 and 2008–2011

“… 30 In repeated population surveys conducted in southern Germany, recommended eye or foot examinations among adults with type 2 diabetes significantly increased between 1999–2001 and 2006–2008 (60.5% vs 71.3% and 37.5% vs 55.1% respectively), as did the use of lipid-lowering drugs (18.0% vs 37.9%), and the percentage of adults with diabetes achieving BP targets of <140/90 mm Hg (43.6% vs 70.5%). 11 These findings are largely consistent with our results. However, unlike our findings, the proportions of persons with diabetes achieving HbA1c targets of <7.0% (53 mmol/mol) and those with a BMI ≤30 kg/m 2 remained unchanged in the previous study.…”

“…In Germany, previous studies of changes in diabetes quality of care indicators over time have been confined to regional population-based studies 11 or studies among primary care patients. 30 In repeated population surveys conducted in southern Germany, recommended eye or foot examinations among adults with type 2 diabetes significantly increased between 1999–2001 and 2006–2008 (60.5% vs 71.3% and 37.5% vs 55.1% respectively), as did the use of lipid-lowering drugs (18.0% vs 37.9%), and the percentage of adults with diabetes achieving BP targets of <140/90 mm Hg (43.6% vs 70.5%).…”

“…However, unlike our findings, the proportions of persons with diabetes achieving HbA1c targets of <7.0% (53 mmol/mol) and those with a BMI ≤30 kg/m 2 remained unchanged in the previous study. 11 In a study based on data from 110 primary care practices across Germany, the proportion of patients with diabetes achieving HbA1c <6.5% (48 mmol/mol) increased from 31% in 1998 to 36% in 2005, while the percentage of patients with HbA1c ≥9.0% (75 mmol/mol) was halved from about 20% to 10% over this time period, 30 roughly comparable to our findings from 23.5% in 1997–1999 to 4.6% in 2008–2011 ( table 2 ). Our findings of improvements in diabetes-related complications among our sample are consistent with a variety of studies using various data sources over the past decade in Germany (eg, regional disease registries or hospital discharge data, selected sickness funds) reporting improvements in amputation rates, the incidence of blindness, and cardiovascular risk reduction, particularly among women.…”

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

“…Noteworthy, except for oral antidiabetic therapy and control of HDL cholesterol, improvements in medication and risk factor control were large comparing 2007 with 2000, but small or non-existent comparing 2014 with 2007. Similar as observed in this study, Schunk et al and Du et al reported in previous work that the proportion of German patients who received regular HbA1c checks and medication with cardio-protective drugs and those with well-controlled blood pressure and lipids increased substantially from 2000 to 2008 [ 21 , 22 ] and 1997–99 to 2008–11 [ 24 ]. This improvement in quality of care in the 2000s years might be related to the introduction of structured DMPs (2003) for type 2 diabetes [ 18 ] as several studies indicated that the introduction of DMPs improved the quality of care of participating patients [ 31 , 32 ] or even caused a spill-over effect which increased the quality of care of all patients with diabetes [ 33 ].…”

Blood Pressure Control Has Improved in People with and without Type 2 Diabetes but Remains Suboptimal: A Longitudinal Study Based on the German DIAB-CORE Consortium

“…The estimates of treated and controlled hypertension remained low at about 56% and 20% with some minor improvement. Using three surveys of the KORA study conducted between 1999 and 2008, Schunk et al found clearer enhancements in blood pressure control in participants with T2D: the proportions of people who achieved the goal blood pressure of < 140/90 mmHg were 43.6%, 55.2%, and 70.5% across the three studies sorted by examination dates [ 33 ].…”