Treatment of diabetes also depends on where patients live in Germany

Study shows: Regional differences in the treatment of diabetes

More and more people in Germany are suffering from diabetes. Although the disease can be well controlled in some cases even without medication, but a large part of those affected will be treated medically. The way the treatment works depends on where the patients live. This has now been shown in a new study.

More than seven and a half diabetics in Germany

According to experts, about 7.6 million Germans are diabetic. More than 90 percent of sufferers suffer from type 2 diabetes. They can often bring the disease naturally under control. It is important to eat healthily, to exercise regularly and to reduce possible overweight. However, patients with type 1 diabetes always require insulin therapy. How the treatment will go down also depends on where the affected people live in Germany.

One study has shown that there are regional differences in the treatment of type 1 diabetes in Germany. Differences were also noted in the treatment results. (Image: Andrey Popov / fotolia.com)

Illness is not treated the same everywhere

According to a report by the German Center for Diabetes Research (DZD), despite significant progress in managing type 1 diabetes in children and adolescents over the past two decades, there are regional differences in treatment.

The use of insulin pumps and fast or long-acting insulin analogues as well as the blood sugar levels (HbA1c), the prevalence of obesity and the rate of severe hypoglycaemia differ by state.

But why are these differences? Is there possibly a connection between the socio-economic conditions of a region and the type of care of children and adolescents with type 1 diabetes??

And can this also be used to derive differences in treatment results? These questions have been investigated by DZD researchers in a recent study.

Also involved in the study were the Institute for Epidemiology and Medical Biometry, ZIBMT of the University of Ulm, the Institute for Biometry and Epidemiology of the German Diabetes Center and the Institute for Health Economics and Management in the Health Care of Helmholtz Zentrum München.

The results were recently published in the journal Diabetes Care.

Regional differences due to lack of resources

To arrive at their findings, the research team evaluated data from the Diabetes Patient History Documentation (DPV) of 29,284 patients under the age of 20 years.

Among other things, they investigated how often pump therapy and fast or long-acting insulin analogues are used and whether continuous tissue glucose measurement (CGMS) is used.

In addition to the type of treatment, treatment results were also examined. Among other things, the quality of the metabolic control (assessed on the basis of the HbA1c value) and the prevalence of obesity in young type 1 diabetes patients were analyzed.

"The study shows that regional differences in therapy and treatment outcomes exist even at county level in young type 1 diabetes patients, and that these geographical differences are partly due to regional deprivation, that is, a regional lack of material and social resources, measured by aggregated socioeconomic indicators ", explains first author and DZD scientist Marie Auzanneau from the Institute for Epidemiology and Medical Biometry, ZIBMT, at the University of Ulm.

Differences in treatment results

For the study, the scientists used the "German of Index Multiple Deprivation 2010" (GIMD 2010) and its subdivision into quintiles (fifth).

According to the data, this deprivation index was designed by the last author and DZD scientist Werner Maier of the Institute for Health Economics and Management in Health Care, Helmholtz Zentrum München, Neuherberg.

The results showed that patients in the socioeconomically most disadvantaged regions were less likely to receive long-acting insulin analogues (64.3%) than patients in the socioeconomically strongest regions (80.8%)..

Continuous glucose monitoring systems (CGMS) are also less frequently used in the socio-economically weakest regions (in 3.4% of patients) than in the socioeconomically strongest regions (in 6.3% of patients).

Differences are also evident in the treatment results. The average HbA1c value is 8.07% (65 mmol / mol) in the socioeconomically weakest regions and 7.84% (62 mmol / mol) in the socioeconomically strongest regions..

In addition, patients in the least favored regions are more likely to be overweight. The prevalence here is 15.5%, in the socioeconomically privileged regions 11.8%.

However, patients in the socioeconomically weakest areas are less frequently affected by severe hypoglycaemia. The rate of severe hypoglycemia here is only 6.9 events per 100 patient-years compared to 12.1 events in the most socio-economically dominant areas.

"Our findings suggest that treatment outcomes for patients in socio-economically disadvantaged regions could improve through more frequent use of pump therapy and continuous tissue glucose measurement," said DZD scientist Stefanie Lanzinger of ZIBMT.

"In order to understand how the individual dimensions of regional deprivation are associated with therapy and treatment outcomes in diabetes care, further investigations will follow", continues Joachim Rosenbauer from the German Diabetes Center in Dusseldorf. (Ad)