High Quality of Diabetes Care Based Upon Individualised Treatment Goals – A Cross Sectional Study in 4784 Patients in Germany

Abstract

Objective: Recent guidelines recommend an individualized approach towards patients with diabetes mellitus. Data of a programme dealing with quality of diabetes care, “Diabetes TÜV” of the Deutsche BKK was reappraised in the light of recent evidence applying these recommendations.

Patients and Methods: Data originates from a population-based study in primary diabetes care in Germany. Patients with diabetes mellitus insured by the Deutsche BKK were invited to participate. From 2000 to 2004 data of 4 784 patients participated. Double or multiple visits were not included. HbA_1c was analysed in 0.5% categories and in age groups below and above 70 years. HbA_1c was DCCT adjusted.

Results: A total of 368 patients with diabetes mellitus type 1 (DM1) (42% women, HbA1c 54 mmol/mol (7.1%), BP 136/79 mmHg) and 4 416 patients with diabetes type 2 (DM2) (44% women, HbA1c 48.6 mmol/mol (6.6%), BP 142/81 mmHg) were included.). An HbA1c of 53 mmol/mol (7%) or less was found in 70%, less than 64 mmol/mol (8%) in 87% of all patients, and higher than 86 mmol/mol (10%) in 2.8%. The detailed analysis shows that an HbA1c of <=47.6 mmol/mol (6.5%) is achieved of 38% of people with DM1 and 56% with DM2, an HbA1c <=66 mmol/mol (8.0%) of 79% and 88%, respectively.

The mean systolic blood pressure (BP) was 142 mmHg, the diastolic BP was 81 mmHg. Systolic BP increased with age (systolic BP: < 50 years 131 mmHg; 50–70 years 142 mmHg; > 70 years 144 mmHg/diastolic BP: < 50 years 81 mmHg; 50–70 years 82 mmHg; > 70 years 80 mmHg). Using WHO grading, BP is mainly mildly elevated (grade 1: 41% (n=1942); grade 2, 17% (n=820) grade 3 6% (n=281). In 10 patients (0.2%) HbA1c above 86 mmol/mol (10.0%) coincides with a BP WHO grade 3.

Conclusions: In recent years new evidence is available regarding treatment targets. The reappraisal of a cross sectional study of a quality assurance programme of a German health insurance in a differentiated way demonstrates that more than 2/3 of the people with diabetes mellitus meet their specific goals. Only very few patients are at imminent risk due to bad glycaemic control and high blood pressure. Old patients may be at risk of overtreatment. Strategies aiming at adapting pharmacological interventions in older patients must be conceived.

Key words

diabetes mellitus - HbA1c - blood pressure - quality of care

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