The impact of a disease management programme for type 2 diabetes on health-related quality of life: multilevel analysis of a cluster-randomised controlled trial

A population-based cohort of adult patients with diabetes mellitus in a Western District of Austria: The Diabetes Landeck cohort

INTRODUCTION

Diabetes mellitus (DM) has become an important and exacerbating health epidemic, with severe consequences for both patients and health systems. The National Diabetes Strategy of Austria addresses the lack of high-quality data on DM in Austria and the need for developing a national data network. The aims of our study are to establish a cohort including all adult diabetes patients in a district in western Austria, describe the demographic and clinical characteristics of this cohort, and provide an estimation of diabetes prevalence.

METHODS

We recruited a population-based cohort of adult patients with a diagnosis of DM in cooperation with a network of all caregivers. Data collection was based on a case report form, including patient characteristics, clinical parameters and long-term complications.

RESULTS

In total, 1845 patients with DM were recruited and analysed. We observed an overall prevalence of 5.3% [95% CI: 5.0%-5.5%]. For the subsequent main analysis, we included 1755 patients with DM after excluding 90 patients with gestational DM. There were significant differences between genders in the distribution of specific clinical parameters, patient characteristics, and the long-term complications diabetic foot, amputation and cardiovascular disease.

CONCLUSION

To the best of our knowledge, we established the first diabetes cohort study in Austria. Prevalence and the proportion of specific long-term complications were lower when compared to the international context. We assume that the Diabetes Landeck Cohort has reached a high degree of completeness; however, we were not able to identify independent data sources for a valid check of completeness.

Disease Management Program in patients with type 2 diabetes mellitus, long-term results of the early and established program cohort: A population-based retrospective cohort study

BACKGROUND

The aim of this study was to evaluate the long-term follow up of the early and the effectiveness of the established program of the Austrian Disease Management Program (DMP) 'Therapie aktiv-Diabetes im Griff' for patients with type 2 diabetes mellitus concerning mortality, major macrovascular complications, costs and process quality of care parameters.

METHODS

We conducted a propensity score matched cohort study based on routine health insurance data for type 2 diabetic patients. The observational period from the matched early program cohort starts from January 1, 2009 to December 31, 2017 and includes 7181 DMP participants and 21543 non-participants. In the established matched program cohort, 3087 DMP participants and 9261 non-participants were observed within January 1, 2014 to December 31, 2017.

RESULTS

In the early program cohort, 22.1% of the patients in the DMP-group and 29.7% in the control-group died after 8 years follow-up (HR = 0.70; 95% CI: 0.66-0.73). A difference of € 1070 (95% bootstrap-T interval: € 723 - € 1412) in mean total costs per year was observed. In the established program cohort, 10.4% DMP participants died 4 years after enrollment, whereas in the control-group 11.9% of the patients died (HR = 0.88, 95% CI: 0.78-0.99). Healthcare utilization is higher in the DMP-group (75%-96%) compared to the control-group (63%-90%).

CONCLUSIONS

The 8-year long-term follow up of the DMP program showed a relevant improvement of survival and healthcare costs of patients with type 2 diabetes. The established program cohort had improved survival and quality of care. Our findings indicate that the DMP "Therapie aktiv" provides a long-term advantage for type 2 diabetes patients.

Intra-individual association between C-reactive protein and insulin administration in postoperative lumbar spinal canal stenosis patients: A retrospective cohort study

The association of intra-individual variability in insulin requirements with C-reactive protein levels among acute phase patients remains unclear. This retrospective cohort study aimed to evaluate this association. Patients with type 2 diabetes undergoing surgery for lumbar spinal canal stenosis were included in the study. We analyzed 286 records of 49 patients using the linear mixed effects model. The model showed C-reactive protein levels to be significantly associated with insulin requirements, with an effect size of 0.60 U/day for an elevation of 1 mg/dL. The effect size was increased in patients with higher hemoglobin A1c levels. Our findings imply that C-reactive protein levels could be a useful clinical biomarker when blood glucose levels are controlled in acute phase patients.