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Quality of diabetes care improves in Germany, still falls short in some areas
Quality-of-care indicators for adults with type 2 diabetes have significantly improved since Germany initiated diabetes disease management programs in 2003, but many patients still do not meet guideline-recommended targets for lifestyle interventions, according to research in BMJ Open Diabetes Research & Care.
In an analysis of two German national health surveys — one initiated before the diabetes disease management programs were put in place; one after — researchers found more patients with type 2 diabetes underwent regular eye and foot exams and practiced better self-monitoring of blood glucose in the later survey, whereas lifestyle measures such as smoking and obesity remained unchanged or increased.
“The results of the present analysis ... show that about two-thirds of persons with type 2 diabetes reached the target HbA1c < 7%, and only 11.4% of patients with diabetes achieved stringent targets in HbA1c, [total cholesterol], [blood pressure], and smoking combined,” Yong Du, PhD, of the department of epidemiology and health monitoring at the Robert Koch Institute in Berlin, and colleagues wrote.
Du and colleagues analyzed data from adults aged 45 to 79 years with type 2 diabetes who completed the German National Health Interview and Examination Survey, conducted between 1997 and 1999 (n = 333), and the National Health Interview and Examination Survey for Adults in Germany, conducted between 2008 and 2011 (n = 526). Participants completed self-administered questionnaires and physician-administered personal interviews regarding diabetes treatment, medications and complications, eye and foot examinations in the past 12 months, SMBG, smoking status, physical activity and whether they had participated in a diabetes education program; physicians measured BMI and BP and collected blood samples.
Researchers found significant improvements in several quality-of-care indicators between the two survey periods, including the number of patients maintaining HbA1c level less than 7% (32.4% vs. 65.4%), BP less than 130/80 mm Hg (32% vs. 47.2%), total cholesterol less than 190 mg/dL (13.5% vs. 41.9%) and use of statins (11.7% vs. 35.9%). The number of patients who underwent yearly eye and foot exams also increased, whereas diabetes-specific complications fell from 29.7% to 21.8% and blood glucose monitoring significantly increased (37.4% vs. 62.8%). However, researchers found that obesity levels rose between surveys and, despite improvements across measures, the proportion of patients achieving combination goals were low in both surveys.
The researchers also noted that, although engagement in sports activities significantly improved between survey periods, fewer than one in five adults in the later survey reported performing more than 2 hours of physical activity per week, still below guideline recommendations of 150 minutes or more per week for adults with diabetes. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.