title: Medical care of type 2 diabetes in German disease management programmes: a population-based evaluation.
abstract: OBJECTIVE
  Type 2 diabetes disease management programmes (DDMPs) are offered by German social health insurance to promote healthcare consistent with evidence-based medical guidelines. The aim of this study was to compare healthcare quality and medical endpoints between diabetes management programme participants and patients receiving usual care designated as controls.
  
  
  METHODS
  All patients with type 2 diabetes (age range: 36-81) in a cross-sectional survey of a cohort study, performed by the Cooperative Health Research in the Region of Augsburg, received a self-administered questionnaire regarding their diabetes care. Physical examination and laboratory tests were also performed. The analysis only included patients with social health insurance and whose participation status in a diabetes disease management program was validated by the primary physician (n = 166). Regression analyses, adjusting for age, sex, education, diabetes duration, baseline waist circumference and clustering regarding primary physician were conducted.
  
  
  RESULTS
  Evaluation of healthcare processes showed that those in diabetes disease management programmes (n = 89) reported medical examination of eyes and feet and medical advice regarding diet [odds ratio (OR): 2.39] and physical activity (OR: 2.87) more frequently, received anti-diabetic medications (OR: 3.77) and diabetes education more often (OR: 2.66) than controls. Both groups had satisfactory HbA(1c) control but poor low-density lipoprotein cholesterol control. Blood pressure goals (<140/90 mmHg) were achieved more frequently by patients in diabetes disease management programmes (OR: 2.21).
  
  
  CONCLUSIONS
  German diabetes disease management programmes are associated with improved healthcare processes and blood pressure control. Low-density lipoprotein cholesterol control must be improved for all patients with diabetes. Further research will be required to assess the long-term effects of this diabetes disease management programme.
authors.affiliation: Helmholtz Zentrum München, Institute for Health Economics and Healthcare Management, Neuherberg, Germany. r.stark@helmholtz-muenchen.de
authors.forename: Reneé G
authors.initials: RG
authors.lastname: Stark
authors.forename: Michaela V
authors.initials: MV
authors.lastname: Schunk
authors.forename: Christine
authors.initials: C
authors.lastname: Meisinger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rathmann
authors.forename: Reiner
authors.initials: R
authors.lastname: Leidl
authors.forename: Rolf
authors.initials: R
authors.lastname: Holle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D019468:Disease Management; D019317:Evidence-Based Medicine; D005260:Female; D005858:Germany; D019538:Health Care Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D011786:Quality Control; D016896:Treatment Outcome; D055105:Waist Circumference
chemical_list: D007004:Hypoglycemic Agents