Treatment of diabetes also depends on where patients live in Germany

Treatment of diabetes also depends on where patients live in Germany

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Study shows: Regional differences in the treatment of diabetes

More and more people in Germany are diagnosed with diabetes. In some cases, the disease can be controlled well without medication, but the majority of those affected are treated by a doctor. How the treatment turns out also depends on where the patients live. This has now been shown in a new study.

More than seven and a half diabetics in Germany

According to experts, around 7.6 million Germans have diabetes. Over 90 percent of those affected suffer from type 2 diabetes. The disease can often be brought under control in a natural way. It is important to eat a healthy diet, exercise regularly and reduce any excess weight. However, insulin therapy is always necessary in patients with type 1 diabetes. How the treatment turns out also depends on where those affected live in Germany.

Illness is not treated equally everywhere

According to a message from the German Center for Diabetes Research (DZD), despite significant progress in the management of type 1 diabetes in children and adolescents, there have been regional differences in treatment over the past two decades.

The use of insulin pumps and fast or long-acting insulin analogues as well as blood sugar levels (HbA1c), the frequency of being overweight and the rate of severe hypoglycaemia differ from state to state.

But why are these differences? Is there possibly a connection between the socio-economic conditions of a region and the type of care for children and adolescents with type 1 diabetes?

And can differences in therapy results be derived from this? Researchers at the DZD have investigated these questions in a recent study.

The study also involved the Institute for Epidemiology and Medical Biometry, ZIBMT at the University of Ulm, the Institute for Biometry and Epidemiology at the German Diabetes Center and the Institute for Health Economics and Health Care Management at the Helmholtz Zentrum München.

The results were recently published in the "Diabetes Care" magazine.

Regional differences due to lack of resources

In order to arrive at their results, the research team evaluated data from the diabetes patient history documentation (DPV) of 29,284 patients under the age of 20.

Among other things, they investigated how often pump therapy and fast or long-acting insulin analogues are used and whether continuous tissue glucose measurement (CGMS) is used.

In addition to the type of treatment, therapy results were also examined. Among other things, the quality of the metabolic control (assessed on the basis of the HbA1c value) and the prevalence of overweight in young type 1 diabetes patients were analyzed.

"The study shows that regional differences in therapy and outcomes in young type 1 diabetes even exist at the district level, and that these geographic differences are due in part to regional deprivation, that is, a regional lack of material and social resources, measured on the basis of aggregated socio-economic indicators, can be explained, ”explains the first author and DZD scientist Marie Auzanneau from the Institute for Epidemiology and Medical Biometry, ZIBMT, at the University of Ulm.

Differences in therapy results

For the study, the scientists used the "German of Index Multiple Deprivation 2010" (GIMD 2010) and its subdivision into quintiles (fifths).

According to the information, this deprivation index was designed by the last author and DZD scientist Werner Maier from the Institute for Health Economics and Management in Health Care, Helmholtz Zentrum München, Neuherberg.

The results showed that patients in the socio-economically most disadvantaged regions received less effective insulin analogues for longer (64.3%) than patients in the socio-economically strongest regions (80.8%).

Continuous glucose monitoring systems (CGMS) are also used less frequently in the socio-economically weakest regions (in 3.4% of the patients) than in the socio-economically strongest regions (in 6.3% of the patients).

There are also differences in the therapy results. The average HbA1c value is 8.07% (65 mmol / mol) in the socio-economically weakest regions and 7.84% (62 mmol / mol) in the socio-economically strongest regions.

In addition, patients in the most disadvantaged regions are more likely to be overweight. The prevalence here is 15.5%, in the socio-economically privileged regions 11.8%.

However, patients in the socio-economically weakest areas are less often affected by severe hypoglycaemia. The rate of severe hypoglycaemia here is only 6.9 events per 100 patient years compared to 12.1 events in the socio-economically strongest areas.

"Our results indicate that the therapy results of patients in socio-economically disadvantaged regions could improve through the more frequent use of pump therapy and continuous tissue glucose measurement," said DZD scientist Stefanie Lanzinger from the ZIBMT.

"In order to understand how the individual dimensions of regional deprivation are associated with the therapy and the therapy results in diabetes care, further studies will follow," continues Joachim Rosenbauer from the German Diabetes Center in Düsseldorf. (ad)

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