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Dtsch Med Wochenschr. 2017 Sep;142(18):e131-e139. doi: 10.1055/s-0043-111388. Epub 2017 Sep 8.

[Implementation of the National Guidelines for the treatment of Diabetes mellitus type 2 in secondary diabetes centers].

[Article in German; Abstract available in German from the publisher]

Author information

1
Universitäts-Augenklinik Tübingen, Eberhard Karls Universität, Tübingen.
2
Autonomes und Neuroendokrinologisches Labor, Department für Neurologie, Universitätsklinikum Carl Gustav Carus, Dresden.
3
Deutsches Zentrum für Diabetesforschung (DZD), Institut für Diabetesforschung und Metabolische Erkrankungen des Helmholtz Zentrums München an der Eberhard Karls Universität, Tübingen.

Abstract

in English, German

Background The German National Disease Management Guideline (NVL) on treatment of Type 2 Diabetes recommends lowering of blood glucose in four therapy steps. There is little evidence, how NVL is implemented for the individual patients. Methods 810 patients in secondary diabetes centers were examined within the DiabCheckOCTplus trial. Data about the patient's health status (electronic medical record) were classified according to the NVL treatment steps. The degree of implementation was assessed for every person with diabetes type 2 (NCT02 311 504). Results Related to the levels of treatment, 81 % of patients received metformin in level 2, 48 % the dual combination of metformin with DPP4-Inhibitors (level 3) and 41 % an intensified insulin therapy in combination with metformin (level 4). The overall percentage for metformin was 67 %, for DPP4-Inhibitors 20 % and 10 % for sulfonylureas.The duration of diabetes significantly increased with higher NVL level. After 3 years of diabetes 55 % received more than one antihyperglycemic drug. Half of the patients were treated with complex insulin strategies after 9 years, however almost all after 25 years. Conclusion The therapy in secondary care centers met national guidelines to a large extent. Similar proof of implementation would be important for primary care by general practitioners. As the factual information of the therapy level strongly correlated with the duration of disease, it might be used for structured communication (risk profile).

PMID:
28902377
DOI:
10.1055/s-0043-111388
[Indexed for MEDLINE]

Conflict of interest statement

Interessenkonflikte: Die DiabCheck-Studie wurde als Investigator-initiated trial (IIT) von Novartis Pharma unterstützt. Lydia Marahrens und Dr. Daniel Röck erhielten keine Honorare. Prof. Tjalf Ziemssen erhielt Unterstützung für wissenschaftliche Studien von Almirall, Bayer-Schering, Biogen Idec, der Deutschen Diabetes Stiftung, Genzyme, GSK, Hertie Foundation, Sanofi-Aventis, Merck Serono, MSD, Novartis, Teva, The Robert Pfleger Foundation und der Roland Ernst Foundation und ist als Berater für Bayer-Schering, Biogen Idec, Novartis und Teva honoriert worden. Raimar Kern erhielt Forschungsunterstützung von Bayer-Healthcare, Biogen Idec, Genzyme, Merck Serono, Novartis und Teva. Prof. Focke Ziemssen erhielt Honorare für Beratungs- und Referententätigkeit von Alimera, Allergan, Bayer-Healthcare und Novartis sowie Honorare im Rahmen von klinischen Studien von Alcon, Allergan, Biogen Idec und Novartis. Prof. Fritsche hat Beratertätigkeiten für Novwo Nordisk, Boehringer Ingelheim und Sanofi Aventis, er war als Gutachter für das IQWIG (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) aktiv und erhielt Referentenhonorare von MSD und Sanofi Aventis.

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