[Quality of care and extent of complications in a population-based sample of patients with type 2 diabetes mellitus. The KORA Survey 2000].
OBJECTIVE
The aim of this study was to analyse health care processes and outcomes in type 2 diabetes in a representative population sample of persons, aged 25-74 years, in the region of Augsburg, Germany.


METHODS
Based on the KORA Survey 2000, indicators of health care services and outcomes were analysed for all study subjects with known type 2 diabetes (n=149; 80 males (54%)) , mean age 62 +/- 9 years; total random population sample: 4,261 persons). Means and prevalences were calculated, including 95% confidence intervals (CI). Associated factors were analysed using multivariate regression models.


RESULTS
57% of the patients had not received adequate drug treatment concerning hypertension and 43% concerning hypercholesterolemia. 63% (CI: 54-70 %) and 38% (CI: 30-47%), respectively, reported that their eyes or feet had been examined during the past 12 months. 47% (CI: 39-56%) had been instructed about their diabetes. 69% (CI: 61-76%) of the subjects did not know the term "HbA(1c)", the proportion being higher among subjects without diabetes education or those of a low social status. 13% (CI: 8-20%) of the subjects had been told by their medical practitioner that they had a retinopathy, 5% (CI: 2- 10%) a foot ulcer, 19% (CI: 12-28%) proteinuria. Two persons were blind, one had been on renal dialysis, and 5% (CI: 2-10%) had undergone amputation of a limb. 6% (3-12%) had at least one of the end-stage diabetic complications. The mean HbA(1c) was 7.2 +/- 1.6%, significantly higher in those with a diabetes for >10 years.


CONCLUSIONS
The population-based data regarding indicators of type 2 diabetes care processes and outcome in a defined region in Germany show that the treatment of hypertension and hypercholesterolemia was highly inappropriate, as was the frequency of medical control investigations. The high proportion of subjects who did not know the term "HbA(1c)" was striking, particularly among those of a low social status. A significant proportion had severe late complications. The mean HbA(1c), however, was better than had been reported in some previous German practice-based studies.
Icks
A
A
Institut für Biometrie und Epidemiologie, Deutsches Diabeteszentrum, Leibniz-Institut an der Heinrich Heine Universität Düsseldorf, Düsseldorf. icks@ddz.uni-duesseldorf.de
Rathmann
W
W
Haastert
B
B
Mielck
A
A
Holle
R
R
Löwel
H
H
Giani
G
G
Meisinger
C
C
D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000628:therapy*; D017719:Diabetic Foot / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D019538:Health Care Surveys; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000592:standards; D011507:Proteinuria / Q000453:epidemiology; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D009626:Terminology as Topic
D006442:Glycated Hemoglobin