Is there a survival benefit within a German primary care-based disease management program?
OBJECTIVE
To compare the mortality rate of patients with type 2 diabetes who were enrolled in the German diabetes disease management program (DMP) with the mortality rate of those who were not enrolled.


METHODS
This observational study was part of the ELSID study (Evaluation of a Large Scale Implementation of disease management programs) in Germany.


METHODS
Participants had type 2 diabetes and were either enrolled or not enrolled in the DMP. The DMP provides systems-based, multifaceted, and patient-centered interventions. To reduce imbalances between the groups, a matched sample was created using sex, age, retirement status, federal state, pharmacy-based cost groups, and diagnostic-cost groups as matching criteria. Cox proportional hazards regression model and the Kaplan-Meier method were used to assess overall mortality. The observation period was 3 years beginning on January 1, 2006.


RESULTS
A total of 11,079 patients were included in the analysis. As of January 1, 2006, 2300 patients were enrolled in the DMP and 8779 were receiving routine care. There were 1927 matched pairs of patients in the DMP group and the non-DMP group. The overall mortality rate was 11.3% in the DMP and 14.4% in the non-DMP group (log-rank test P <.01).


CONCLUSIONS
We found an association between participation in the German diabetes DMP and reduced mortality. This reduced mortality cannot be attributed directly to the DMP. However, further research should evaluate whether a primary care-based DMP contributes to increased life expectancy in patients with diabetes.
Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany. antje.miksch@med.uniheidelberg.de
Antje
A
Miksch
Gunter
G
Laux
Dominik
D
Ose
Stefanie
S
Joos
Stephen
S
Campbell
Burgi
B
Riens
Joachim
J
Szecsenyi
D000368:Aged; D018849:Controlled Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005858:Germany / Q000453:epidemiology; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000379:methods; D012648:Self Care / Q000379:methods; D016019:Survival Analysis