[Quality of care of patients with diabetes mellitus living in a rural area of Germany]

[Metabolic control in patients with type-1 and type-2 diabetes mellitus receiving ambulatory care from general practitioners: results of a cross-sectional trial performed in the German federal states of Thuringia and West Pomerania]

Up to the present moment there has been a large controversy over the metabolic control in patients with type-1 and type-2 diabetes mellitus receiving ambulatory treatment from general practitioners. Hence this trial aimed to assess the parameters of treatment quality in patients under ambulatory care in two German regions.

PATIENTS AND METHODS

A total of 2,242 patients from 25 general practitioners' care units were assessed from October 1998 to September 1999.

RESULTS

The mean age of the patients was 67.5 +/- 13.1, and the mean diabetes duration was 8.8 +/- 7.5 years. 26.1% of the patients were treated without using anti-diabetic drugs, and 44.2% took oral anti-diabetic medications. 20.0% received insulin alone and 9.5% a combination therapy of insulin and oral anti-diabetic agents. The mean HbA1c of 6.9 +/- 1.5 was comparable in Thuringia and West Pomerania. It was measured in 68.4% of the patients. Blood pressure values were documented in 98.8%. A total of 31.6% of patients took part in structured diabetes treatment and teaching programmes. In Thuringia the percentage of patients under specialized diabetes care was 3.6%; in West Pomerania it was significantly lower (18%, p<0.001).

CONCLUSION

The quality of treatment and metabolic control in patients with type-1- and type-2 diabetes mellitus receiving ambulatory care from general practitioners is much better than is commonly assumed. However, as indicated by the relatively low frequency of HbA1c measurements, the treatment quality is far from reaching the requirements of national guideline recommendations.

[Quality of life and degree of control in type 2 diabetics seen in primary care]

OBJECTIVE

To analyse the health-related quality of life (HRQL) of type 2 diabetic patients (DM2) and to study the possible influence of this on the metabolic control of the disease and the associated diseases.

MATERIAL AND METHODS

Cross-sectional descriptive study of HRQL using a general questionnaire with COOP/WONCA cartoons and evaluation of compliance with the control criteria.

RESULTS

A total of 98 patients with an average age of 72.9+/-9.9 years were studied, of which a total of 44.8% had a total score of <15 in the questionnaire. In the "overall health" dimension, 64.2% scored it between good and excellent. Almost 70% showed that they did not have physical or emotional health limitation in their social activities, and 42.9% had not suffered any pain in the previous two weeks. A total of 57.1% did not have difficulty when carrying out normal activities or tasks, and 55% said that they could only do light or very light physical activity for 2 minutes. Degree of control: 50% HbA(1c) <7%; 68.4% total cholesterol <200 mg/dl; 26.5% LDL-cholesterol <100 mg/dl; 69.4% HDL-cholesterol >40 mg/dl; 86.7% triglycerides <150 mg/dl; 51% blood pressure (BP) <130/80 mmHg and 90.8% did not smoke. Only 9.1% simultaneously fulfil the objectives for BP, LDL-cholesterol and HbA(1c). We did not find any relationship between the total score obtained in the questionnaire and age, the number of associated DM2 diseases or the number of control criteria accomplished or differences between the average values of the total score of the questionnaire and the gender of the patient.

CONCLUSION

The HRQL and the degree of DM2 control in our patients can be considered good. We did not identify factors related to the control that influence their quality of life.

Diabetes mellitus in Deutschland

Diabetes mellitus is one of the most prevalent endocrine disorders in Germany. Secondary diseases and complications have serious effects on the lives of diabetics. They also represent an important challenge for economic and health policy processes. According to the 2003 Telephone Health Survey, the prevalence of diabetes mellitus among the population aged 18 years and older is 6.1% for women and 5.4% for men. The percentage of diabetics among older population groups is considerably higher (65+: 16%). The need for effective health care for diabetes patients is reflected in frequent medical consultations. At the same time, there are deficiencies in the treatment of diabetes, for example in HbA1c measurement and the examination of diabetics' ocular fundus and feet. Although special training courses for diabetics are well publicized, only one in two diabetics makes use of them. Future surveys will show whether disease management programmes can help bridge the existing health care gaps.