[Disease management program (DMP) diabetes mellitus: simulation of therapeutic results of different guidelines. A new diabetes mellitus model (DMM)].
OBJECTIVE
In conjunction with the introduction of disease management programmes in Germany there is an ongoing scientific debate on the desirable goals for HbA1c in the management of patients with type 2 diabetes mellitus.


METHODS
In this study, a novel computer-based simulation model (diabetes mellitus model = DMM) was used to estimate the consequences of different levels of metabolic control as assessed by HbA1c for the development of short- and long-term complications of this disease.


RESULTS
At a mean difference of 1 % the rate of severe hypoglycaemic events over 10 years was by 32-84 % higher in those with a lower HbA1c. In contrast, the incidence of microvascular complications (proliferative retinopathy, end-stage kidney disease, clinical neuropathy) was by 20-33 % lower in the group with the lower as compared to the higher HbA1c level according to the scenario applied. The rates of myocardial infarction and stroke were reduced by 15-20 % under these conditions.


CONCLUSIONS
This model calculation suggests that a more strict metabolic control in patients with type 2 diabetes mellitus results in a greater reduction of microvascular complications than of macrovascular complications, but is associated with a higher rate of hypoglycaemic episodes. The diabetes mellitus model is a non-expensive alternative to simulate clinically relevant questions on the management of type 2 diabetes and to provide rapid and realistic answers.
Hauner
H
H
Klinische Abteilung, Deutsches Diabetes-Forschungsinstitut an der Heinrich-Heine-Universität Düsseldorf.hauner@ddfi.uni-dusseldorf.de
Maxion-Bergemann
S
S
Müller
E
E
Schulz
M
M
Huppertz
E
E
Bergemann
R
R
D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D003198:Computer Simulation; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000517:prevention & control; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000517:prevention & control; D003929:Diabetic Neuropathies / Q000453:epidemiology / Q000517:prevention & control; D003930:Diabetic Retinopathy / Q000453:epidemiology / Q000517:prevention & control; D019468:Disease Management; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology / Q000517:prevention & control*; D008875:Middle Aged; D012307:Risk Factors
D006442:Glycated Hemoglobin