"Diabetes in Germany"(DIG) study. A prospective 4-year-follow-up study on the quality of treatment for type 2 diabetes in daily practice
Dtsch Med Wochenschr. 2009 Feb;134(7):291-7 Ott P, Benke I, Stelzer J, Köhler C, Hanefeld M. Weisseritzel-Kliniken, Freital/Dippoldiswalde, Freital.
INTRODUCTION: The efficacy of a multifactorial intervention with antihypertensive drugs, statins and acetylsalicylic acid was shown in the STENO 2 trial of diabetic patients with microalbuminuria. But how good is clinical practice in Germany? The DIG (Diabetes in Germany) study was an prospective survey, analysing the quality of risk factor control and treatment patterns of type 2 diabetics over 4 years between 2002 and 2007.
METHODS: A total of 4020 type 2 diabetics (aged 35 - 80 years) were recruited by 238 physicians across Germany. Their medical history, risk factor profile and clinical data were recorded. The quality of control of diabetes, hypertension or hyperlipidemia and the use of aspirin were assessed in 2914 patients at baseline and after 3,7 years.
RESULTS: The mean HbA (1c) value was 6,98 % at baseline and 7,03 at the study end. 42,9 % at the beginning vs. 36,9 % at follow-up had HbA (1c) values above the target level of 6,5 %. Mean blood pressure was 139,3/80.0 compared with 137,3/79.9 mm Hg (p < 0,01), while 24,1 % and 27,0 %, respectively had values above the target level. Mean LDL-cholesterol levels were 3,23 mmol/l and 2,93 mmol/l, respectively, but only 23,2 % and 30,4 % of patients, respectively, reached target levels. There was a significant increase in the use of antihypertensive drugs, statins and acetylsalicylic acid over the four-year period.
CONCLUSION: Type 2 diabetics in Germany received an acceptable level of treatment for hyperglycaemia, but still more than 60 % of the patients have HbA (1c) values higher than 6,5 %. There are serious deficits in the management of hypertension, hypercholesterolemia and the use of aspirin. Because intensive, multifactorial care of type 2 diabetics leads to reduced rates of death and cardiovascular disorders, these results indicate that the early and meticulous implementation of current treatment guidelines remains a major challenge.