Mehring Michael, Donnachie Ewan, Bonke Florian Cornelius, Werner Christoph, Schneider Antonius
Institute of General Practice, Technische Universität München, Orleansstraße 47, 81667 Munich, Germany.
Association of Statutory Health Insurance Physicians of Bavaria, Elsenheimerstraße 39, 80687 Munich, Germany.
Diabetol Metab Syndr. 2017 May 18;9:37. doi: 10.1186/s13098-017-0236-y. eCollection 2017.
The primary aim of the disease management program (DMP) for patients with diabetes mellitus type 2 is to improve the quality of health care and the treatment process. 12 years after its introduction in Germany, there is still no consensus as to whether DMP has been effective in reaching these goals.
A retrospective longitudinal population-based study between 2004 and 2015 were conducted to evaluate the DMP for type 2 diabetes in Bavaria using routinely collected patient medical records hold from the National Association of Statutory Health Insurance Physicians of Bavaria.
During the first 12 years of DMP, the number of participants increased continually to reach 580,222 in 2015. The proportion of participants older than 70 years increased during the observation from 41.6 to 51.1%. The percentage of smokers increased slightly from 9 to 11%. Similarly, the distribution of body mass index remained constant with approximately 50% of patients having a body mass index >30 kg/m. Control of HbA1c was without an appreciable change over the course, with between 8.3 and 9.4% of all patients with uncontrolled values higher than 8.5%. Prescription of metformin increased from 40.5% in 2004 to 54.1% in 2015. Among patients receiving insulin, the proportion receiving a combined therapy with metformin increased from 28.4% in 2004 to 50.8% in 2015. In contrast, the percentage with insulin monotherapy decreased from 55.4 to 33.7%. The proportion of patients with a diabetic education increased within the course from 12.8 to 29.3%.
Data from the German DMP for type 2 diabetes demonstrates an improvement in the quality of care with respect to pharmacotherapy and patient education and therefore to an improved adherence to guidelines. However, no appreciable improvement was observed with regard to smoking status, obesity or HbA1c control.
2型糖尿病患者疾病管理项目（DMP）的主要目标是提高医疗保健质量和治疗过程。在德国引入该项目12年后，对于DMP是否有效实现这些目标仍未达成共识。
进行了一项2004年至2015年基于人群的回顾性纵向研究，以使用巴伐利亚法定健康保险医师全国协会常规收集的患者病历评估巴伐利亚州的2型糖尿病DMP。
在DMP实施的前12年中，参与者数量持续增加，2015年达到580,222人。70岁以上参与者的比例在观察期间从41.6%增加到51.1%。吸烟者的百分比从9%略有增加到11%。同样，体重指数的分布保持不变，约50%的患者体重指数>30kg/m²。糖化血红蛋白（HbA1c）的控制在整个过程中没有明显变化，所有患者中HbA1c未得到控制（值高于8.5%）的比例在8.3%至9.4%之间。二甲双胍的处方率从2004年的40.5%增加到2015年的54.1%。在接受胰岛素治疗的患者中，接受二甲双胍联合治疗的比例从2004年的28.4%增加到2015年的50.8%。相比之下，单纯胰岛素治疗的比例从55.4%下降到33.7%。接受糖尿病教育的患者比例在过程中从12.8%增加到29.3%。
德国2型糖尿病DMP的数据表明，在药物治疗和患者教育方面护理质量有所提高，因此对指南的依从性也有所提高。然而，在吸烟状况、肥胖或HbA1c控制方面未观察到明显改善。
