Structural and process quality in the management of diabetic emergencies in Germany.
OBJECTIVE
Although acute complications of diabetes account for approximately 3% of all emergency calls, clinically relevant indicators of structural and process quality in the management of diabetic emergencies have not yet been studied. The purpose of this investigation was, therefore, to collect representative data on these indicators for the whole of Germany.


METHODS
Standardized questionnaires comprising 20 items were sent to all 312 emergency medical services in Germany. Apart from demographic data, information was obtained about the diagnostic materials and drugs carried by the ambulances, methods of blood glucose measurement, the level of qualification of the emergency teams, the frequency of diabetic emergencies, and the need for further training.


RESULTS
The return rate of the questionnaires was 55%, corresponding to 172 emergency medical service districts serving a total population of 45.3 million. The data revealed deficits with regard to structural and process quality. Thus, only 6% of ambulances carried glucagon and only 11% ketone test strips. In 57% capillary blood was used for glucose determination, in 17% visually read test strips were still used. While in some districts hospital admission after hypoglycaemic episodes was mandatory even for patients well educated about their diabetes, in other districts multimorbid patients on oral antidiabetics were sometimes only treated at the emergency scene. Emergency medical technicians increasingly carried out both the diagnosis and treatment of diabetic emergencies.


CONCLUSIONS
The structural and process quality of the management of diabetic emergencies in Germany is in need of improvement. The most important factor is continuing education of the entire emergency team.
Holstein
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1st Department of Medicine, Klinikum Lippe-Detmold, Detmold, Germany. Andreas.Holstein@t-online.de
Plaschke
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Schlieker
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Egberts
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EH
D000208:Acute Disease; D001786:Blood Glucose / Q000032:analysis; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000628:therapy*; D003926:Diabetic Coma / Q000209:etiology / Q000628:therapy; D004630:Emergencies; D004632:Emergency Medical Services / Q000592:standards*; D004635:Emergency Medicine / Q000193:education / Q000592:standards*; D005858:Germany; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology / Q000628:therapy; D017064:Process Assessment, Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
D001786:Blood Glucose