Lippmann-Grob B, Bierwirth R A, Kron P, Leinhos B, Funke K, Huptas M, Grüneberg M, Weich K W, Münscher C, Potthoff F
Diabetologische Schwerpunktpraxis, Diabetologe DDG.
Dtsch Med Wochenschr. 2004 Jan 16;129(3):75-81. doi: 10.1055/s-2004-816292.
Disease management programs (DMP) e. g. for diabetes mellitus, should be the clinical and economic basis for a structured treatment. This article shows results of specialized outpatient treatment using a risk factor depending patient classification.
Diabetes associated co-morbidities, micro- and macrovascular complications, the results and findings of blood pressure and metabolism of glucose and lipids, as well as all treatment-associated costs of 5245 type 2 diabetics were collected for a period of 12 months, accompanied by different measures of quality control. For documentation in the centres, all available original data were used as local data sources.
The patient classification system, on which diabetic risk profiles are based, covered 74.3 % of all type 2 diabetic patients. Daily direct costs for all treatment measures ranged between EUR 4.79 (primary prevention) and EUR 8.96 for patients suffering from advanced diabetic foot syndrome. Most of the treatment costs arose from prescriptions of pharmaceuticals, other remedies and aids. Specific strategies of therapy were both related to the severity of co-morbidities and the time since manifestation of diabetes (r = 0.486; p < 0.01, two-sided). The share of patients receiving diet and exercise only decreased from 22.8 % (primary prevention) to below 10 % of patients suffering from microvascular complications. Simultaneously, the share of patients receiving insulin increased up to 81.8 % of patients suffering from advanced diabetic retinopathy.
The risk profile specific variation in the results clearly shows the need of a risk factor depending classification system for type 2 diabetes, which could be useful to reform and focus the system of compensating payments between health insurance companies more and more on morbidity, or on risk profiles.
疾病管理项目（如糖尿病管理项目）应成为结构化治疗的临床和经济基础。本文展示了基于风险因素的患者分类进行专科门诊治疗的结果。
收集了5245例2型糖尿病患者在12个月期间的糖尿病相关合并症、微血管和大血管并发症、血压以及血糖和血脂代谢的结果与发现，以及所有与治疗相关的费用，并伴有不同的质量控制措施。为在各中心进行记录，所有可用的原始数据都被用作本地数据源。
糖尿病风险评估所依据的患者分类系统涵盖了所有2型糖尿病患者的74.3%。所有治疗措施的每日直接费用在4.79欧元（一级预防）至患有晚期糖尿病足综合征患者的8.96欧元之间。大部分治疗费用来自药品、其他治疗手段和辅助器具的处方。具体的治疗策略既与合并症的严重程度有关，也与糖尿病发病后的时间有关（r = 0.486；p < 0.01，双侧）。仅接受饮食和运动治疗的患者比例从22.8%（一级预防）降至患有微血管并发症患者的10%以下。同时，接受胰岛素治疗的患者比例在患有晚期糖尿病视网膜病变的患者中升至81.8%。
结果中特定风险评估的差异清楚地表明，2型糖尿病需要一个基于风险因素的分类系统，这可能有助于使健康保险公司之间的赔付支付体系越来越多地围绕发病率或风险评估进行改革和聚焦。
