Population-Based Measurement of Quality of Diabetes Care Using HbA1c Values in the State of Thuringia/Germany

Abstract

Mean HbA1c as an indicator of glycaemic control of diabetes patients in primary care in Thuringia was good. The percentage of patients who need immediate medical intervention to prevent acute complications varied between districts, which is indicative for differences in quality of diabetes care in Thuringia. However, the proposed method is still experimental and has not yet been evaluated. Consequently, considerable bias might influence the results.

High Quality of Diabetes Care Based Upon Individualised Treatment Goals – A Cross Sectional Study in 4784 Patients in Germany

“…Overall it can be stated that people with diabetes mellitus on primary care level in Germany are mostly meeting the glycaemic and BP treatment targets postulated in recent recommendations and guidelines. These findings are in agreement with similar data from the nationwide DMP diabetes mellitus [34] and to other results on primary care level in Germany [35][36][37], Norway [38] and Denmark [39] and also to HbA 1c data retrieved directly and unselected from biochemical laboratories [40]. The contrast in the interpretation of similar data in the GUIDANCE-study [3] derives from less rigid treatment goals but also from a more differentiated approach to the data.…”

“…A selection bias may have occurred by the fact that "Deutsche BKK" has traditionally insured employees with a comparably higher socio-economic standard. We think this is unlikely though, as a survey with a selection free electronical data collection form the central labs yielded a comparable HbA 1c [40]. Another cause of patient selection may be the voluntary participation of physicians and patients in the quality assurance programme.…”

Telephone follow‐up to improve glycaemic control in patients with Type 2 diabetes: systematic review and meta‐analysis of controlled trials

“…Achieving optimal glycaemic control (HbA 1c ≤ 7%, 53 mmol/mol) is a key clinical objective in reducing complications [1]. While there is evidence to suggest that, overall, more patients are achieving better diabetes control [12–4], patients still require a great deal of support if they are to maintain good control. A key factor in determining whether patients will achieve and maintain optimal glycaemic control is the extent to which they are able to translate complex self‐care advice into competent self‐care behaviours (taking medication correctly, monitoring blood‐glucose levels and maintaining a ‘healthy’ diet and exercise regime).…”

Quality of Care of People With Type 2 Diabetes in Eight European Countries

“…A range of such factors has been previously identified, for example, management by specialists or nonspecialists (14), socioeconomic differences (15–17), ethnic minority status (15,18), and duration of diabetes (19). Geographical differences also have been described, including large variations in the quality of care between districts within the state of Thuringia in Germany (20) and between states in the United States (21). Similarities and differences within and between countries may be partly explained by factors such as deprivation, as listed, but additional considerations, including the organization and financing of care, also may contribute.…”