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Fan M, Stephan AJ, Emmert-Fees K, Peters A, Laxy M. Health and economic impact of improved glucose, blood pressure and lipid control among German adults with type 2 diabetes: a modelling study. Diabetologia 2023; 66:1693-1704. [PMID: 37391625 PMCID: PMC10390361 DOI: 10.1007/s00125-023-05950-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/18/2023] [Indexed: 07/02/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to estimate the long-term health and economic consequences of improved risk factor control in German adults with type 2 diabetes. METHODS We used the UK Prospective Diabetes Study Outcomes Model 2 to project the patient-level health outcomes and healthcare costs of people with type 2 diabetes in Germany over 5, 10 and 30 years. We parameterised the model using the best available data on population characteristics, healthcare costs and health-related quality of life from German studies. The modelled scenarios were: (1) a permanent reduction of HbA1c by 5.5 mmol/mol (0.5%), of systolic BP (SBP) by 10 mmHg, or of LDL-cholesterol by 0.26 mmol/l in all patients, and (2) achievement of guideline care recommendations for HbA1c (≤53 mmol/mol [7%]), SBP (≤140 mmHg) or LDL-cholesterol (≤2.6 mmol/l) in patients who do not meet the recommendations. We calculated nationwide estimates using age- and sex-specific quality-adjusted life year (QALY) and cost estimates, type 2 diabetes prevalence and population size. RESULTS Over 10 years, a permanent reduction of HbA1c by 5.5 mmol/mol (0.5%), SBP by 10 mmHg or LDL-cholesterol by 0.26 mmol/l led to per-person savings in healthcare expenditures of €121, €238 and €34, and 0.01, 0.02 and 0.015 QALYs gained, respectively. Achieving guideline care recommendations for HbA1c, SBP or LDL-cholesterol could reduce healthcare expenditure by €451, €507 and €327 and gained 0.03, 0.05 and 0.06 additional QALYs in individuals who did not meet the recommendations. Nationally, achieving guideline care recommendations for HbA1c, SBP and LDL-cholesterol could reduce healthcare costs by over €1.9 billion. CONCLUSIONS/INTERPRETATION Sustained improvements in HbA1c, SBP and LDL-cholesterol control among diabetes patients in Germany can lead to substantial health benefits and reduce healthcare expenditures.
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Affiliation(s)
- Min Fan
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.
- German Center for Diabetes Research (DZD), Munich, Germany.
- Institute of Health Economics and Health Care Management, Helmholtz Munich, Munich, Germany.
| | - Anna-Janina Stephan
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Munich, Munich, Germany
| | - Karl Emmert-Fees
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Munich, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Munich, Munich, Germany
| | - Michael Laxy
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Munich, Munich, Germany
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2
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Li X, Jansåker F, Sundquist J, Crump C, Hamano T, Sundquist K. Neighborhood deprivation in relation to lung cancer in individuals with type 2 diabetes-A nationwide cohort study (2005-2018). PLoS One 2023; 18:e0288959. [PMID: 37478113 PMCID: PMC10361504 DOI: 10.1371/journal.pone.0288959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/07/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Neighborhood deprivation has been found associated with both type 2 diabetes and lung cancer. The aim of this study was to examine the potential association between neighborhood deprivation and lung cancer incidence or mortality in individuals diagnosed with type 2 diabetes. The results may identify a new risk or prognostic factor for lung cancer in this important subgroup and help develop a more contextual approach to prevention that includes neighborhood environment. METHODS AND FINDINGS The study population included adults (n = 613,650) aged ≥ 30 years with type 2 diabetes during 2005 to 2018 in Sweden. Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incidence or mortality of lung cancer associated with neighborhood deprivation. All models were conducted in both men and women and adjusted for individual-level characteristics (e.g. age, smoking- and alcohol-related comorbidities, sociodemographic factors). The cumulative incidence and mortality for lung cancer were 1.08% (95% CI, 1.06 to 1.11) and 0.93% (0.90 to 0.95), respectively, in the study population during the study period. Neighborhood deprivation was associated with both incidence and mortality of lung cancer in patients with type 2 diabetes independently of the individual-level characteristics. In the fully adjusted models, comparing high- with low-deprivation neighborhoods, the HRs for lung cancer incidence were 1.21 (1.10 to 1.33) in men and 1.08 (0.95 to 1.21) in women. The corresponding HRs for lung cancer mortality were 1.04 (1.00 to 1.07) in men and 0.97 (0.94 to 1.00) in women. Competing risk analyses including cardiovascular mortality attenuated the results. CONCLUSION In this large cohort of individuals with type 2 diabetes, we found higher lung cancer incidence and mortality in patients living in areas with high neighborhood deprivation, even after adjusting for individual-level characteristics. These findings may help develop a more contextual approach that includes the neighborhood environment when allocating resources for disease prevention and care in patients with type 2 diabetes. These findings could also help inform clinical care for patients with type 2 diabetes, particularly those living in deprived neighborhoods.
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Affiliation(s)
- Xinjun Li
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Filip Jansåker
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Clinical Microbiology, Center of Diagnostic Investigations, Rigshospitalet, Copenhagen, Denmark
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Matsue, Shimane, Japan
| | - Casey Crump
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Tsuyoshi Hamano
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Matsue, Shimane, Japan
- Department of Sports Sociology and Health Sciences, Kyoto Sangyo University, Kyoto, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Matsue, Shimane, Japan
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Dierx JAJ, Kasper HDP. The magnitude and importance of perceived health dimensions define effective tailor-made health-promoting interventions per targeted socioeconomic group. Front Public Health 2022; 10:849013. [PMID: 36324452 PMCID: PMC9618935 DOI: 10.3389/fpubh.2022.849013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 09/06/2022] [Indexed: 01/21/2023] Open
Abstract
Recent insights and developments on health and society urge a critical look at the positive relationship between socioeconomic status (SES) and health. We challenge the notions that it is sufficient to distinguish only between two groups of SES (low and high) and that only overall health is taken into account. A new grouping of SES was developed based on both income and education, resulting in six SES groups. Health was defined in terms of a new positive health concept, operationalized into six health dimensions generating a measure of total general health (TGH). Next, six socioeconomic and demographic determinants of health were included. Linear regression, T-tests and one-way ANOVA were applied to investigate the relationships in a Dutch sample. A subjective way to measure health was applied: self-rated health (SRH). As a result, four out of six dimensions of health determined TGH: bodily functions, daily functioning, quality of life, and social and societal participation. Three out of six socioeconomic and demographic determinants impacted TGH: housing situation, age, and difficulties meeting financial obligations. While this is the general picture for the entire sample, there were interesting similarities and differences between the six SES groups. The similarities lie in the positive impact of the evaluation of bodily functions and daily functioning on TGH in all SES groups. The other dimensions affected TGH in some groups, and some dimensions only in one SES group. None of the socioeconomic and demographic determinants affected TGH in all SES groups. New insights on health inequalities are provided. It is concluded, first that the well-known positive relationship between SES and health is confirmed in this study. Second, further refining the health concept into six dimensions provides more detailed insights on which dimensions impact health the most. The subjective approach applied offers more refined information to better understand which health issues really matter to people. This yields new insights to develop tailor-made interventions aimed at increasing healthy behaviour in specific societal groups.
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Affiliation(s)
- John A. J. Dierx
- Department of Caring Society, Research Group Living in Motion, Avans University of Applied Science, Breda, Netherlands,*Correspondence: John A. J. Dierx
| | - Hans D. P. Kasper
- Department of Marketing and Market Research, Maastricht University School of Business and Economics, Maastricht University, Maastricht, Netherlands
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Hartmann B, Bramlage P, Lanzinger S, Danne T, Hummel M, Kaltheuner M, Raddatz D, Rathmann W, Reuter HM, Seufert J, Holl RW. Regional differences in type 2 diabetes treatment and outcomes in Germany-An analysis of the German DPV and DIVE registries. Diabetes Metab Res Rev 2018; 34:e3049. [PMID: 30051605 DOI: 10.1002/dmrr.3049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 01/08/2023]
Abstract
AIMS On the basis of the Diabetes Versorgungs-Evaluation (DIVE) and Diabetes-Patienten-Verlaufsdokumentation (DPV) datasets, we aimed to explore the impact of differences in treatment modalities on outcomes in Germany and put these into a global context. METHODS The 2014 to 2016 DIVE and DPV databases were combined, and a total of 127 838 patients 18 years and older was analysed with respect to demographics, cardiovascular risk factors, comorbidities, treatments, and outcomes, separately for each German state. Estimates were expressed as adjusted least squares means together with 95% confidence intervals. RESULTS Saarland dataset recorded the lowest mean HbA1c (6.7%; 6.6%-6.8%; 50 mmol/mol, 49-51 mmol/mol), Saxony-Anhalt showed the highest (8.3%; 8.2%-8.3%; 67 mmol/mol, 66-67 mmol/mol). The highest percentage of hypoglycaemic events was reported in Mecklenburg-West Pomerania (MWP) (4.7%; 3.9%-5.7%), the lowest in Thuringia (0.9%; 0.2%-3.4%). Metformin and sulfonylurea accounted for 36.4% to 53.3% of anti-diabetic treatments across states; other antihyperglycaemic drugs such as DPP-4 inhibitors, SGLT2 inhibitors, and GLP-1 analogues were used most often in MWP (40.0%; 37.8%-42.1%) and least in Rhineland-Palatinate (13.6%; 13.0%-14.2%). Treatment with insulin (alone or in combination) was reported most often in MWP (78.2%; 76.4%-80.0%) and least in Thuringia (26.0%; 20.1%-32.9%). CONCLUSIONS Federal states in Germany are heterogeneous concerning diabetes treatment and associated outcomes. These data should stimulate further discussion about how optimal diabetes care can be implemented in all areas of Germany, to achieve good treatment outcomes in all federal states.
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Affiliation(s)
- Bettina Hartmann
- Department of Gastroenterology and Diabetology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Mahlow, Germany
| | - Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Thomas Danne
- Diabeteszentrum für Kinder und Jugendliche, Kinderkrankenhaus auf der Bult, Hannover, Germany
| | - Michael Hummel
- Diabetes Schwerpunktpraxis Rosenheim & Helmholtz Diabetes Center, Munich, Germany
| | - Matthias Kaltheuner
- Gemeinschaftspraxis für Diabetologie, Innere Medizin und Allgemeinmedizin in Leverkusen, Leverkusen, Germany
| | - Dirk Raddatz
- Department of Gastroenterology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany
| | - Hans-Martin Reuter
- Diabetologische Gemeinschaftspraxis Reuter, Reuter-Ehrlich, Schramm, Jena, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
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The contribution of health behaviors to socioeconomic inequalities in health: A systematic review. Prev Med 2018; 113:15-31. [PMID: 29752959 DOI: 10.1016/j.ypmed.2018.05.003] [Citation(s) in RCA: 199] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 05/02/2018] [Accepted: 05/05/2018] [Indexed: 12/22/2022]
Abstract
Unhealthy behaviors and their social patterning have been frequently proposed as factors mediating socioeconomic differences in health. However, a clear quantification of the contribution of health behaviors to the socioeconomic gradient in health is lacking. This study systematically reviews the role of health behaviors in explaining socioeconomic inequalities in health. Published studies were identified by a systematic review of PubMed, Embase and Web-of-Science. Four health behaviors were considered: smoking, alcohol consumption, physical activity and diet. We restricted health outcomes to cardiometabolic disorders and mortality. To allow comparison between studies, the contribution of health behaviors, or the part of the socioeconomic gradient in health that is explained by health behaviors, was recalculated in all studies according to the absolute scale difference method. We identified 114 articles on socioeconomic position, health behaviors and cardiometabolic disorders or mortality from electronic databases and articles reference lists. Lower socioeconomic position was associated with an increased risk of all-cause mortality and cardiometabolic disorders, this gradient was explained by health behaviors to varying degrees (minimum contribution -43%; maximum contribution 261%). Health behaviors explained a larger proportion of the SEP-health gradient in studies conducted in North America and Northern Europe, in studies examining all-cause mortality and cardiovascular disease, among men, in younger individuals, and in longitudinal studies, when compared to other settings. Of the four behaviors examined, smoking contributed the most to social inequalities in health, with a median contribution of 19%. Health behaviors contribute to the socioeconomic gradient in cardiometabolic disease and mortality, but this contribution varies according to population and study characteristics. Nevertheless, our results should encourage the implementation of interventions targeting health behaviors, as they may reduce socioeconomic inequalities in health and increase population health.
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Claessen H, Narres M, Haastert B, Arend W, Hoffmann F, Morbach S, Rümenapf G, Kvitkina T, Friedel H, Günster C, Schubert I, Ullrich W, Westerhoff B, Wilk A, Icks A. Lower-extremity amputations in people with and without diabetes in Germany, 2008-2012 - an analysis of more than 30 million inhabitants. Clin Epidemiol 2018; 10:475-488. [PMID: 29719421 PMCID: PMC5916260 DOI: 10.2147/clep.s146484] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background and purpose Lower-extremity amputations (LEAs) in people with diabetes are associated with reduced quality of life and increased health care costs. Detailed knowledge on amputation rates (ARs) is of utmost importance for future health care and economics strategies. We conducted the present cohort study in order to estimate the incidences of LEA as well as relative and attributable risk due to diabetes and to investigate time trends for the period 2008–2012. Methods On the basis of the administrative data from three large branches of German statutory health insurers, covering ~34 million insured people nationwide (about 40% of the German population), we estimated age-sex-standardized AR (first amputation per year) in the populations with and without diabetes for any, major, and minor LEAs. Time trends were analyzed using Poisson regression. Results A total of 108,208 individuals (diabetes: 67.3%; mean age 72.6 years) had at least one amputation. Among people with diabetes, we observed a significant reduction in major and minor ARs during 2008–2012 from 81.2 (95% CI 77.5–84.9) to 58.4 (55.0–61.7), and from 206.1 (197.3–214.8) to 177.0 (169.7–184.4) per 100,000 person-years, respectively. Among people without diabetes, the major AR decreased significantly from 14.3 (13.9–14.8) to 11.6 ([11.2–12.0], 12.0), whereas the minor AR increased from 15.8 (15.3–16.3) to 17.0 (16.5–17.5) per 100,000 person-years. The relative risk (RR) comparing the diabetic with the nondiabetic populations decreased significantly for both major and minor LEAs (4% and 5% annual reduction, respectively). Conclusion In this large nationwide population, we still found higher major and minor ARs among people with diabetes compared with those without diabetes. However, AR and RR of major and minor LEAs in the diabetic compared with the nondiabetic population decreased significantly during the study period, confirming a positive trend that has been observed in smaller and regional studies in recent years.
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Affiliation(s)
- Heiner Claessen
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ) Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Maria Narres
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ) Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | | | - Werner Arend
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Stephan Morbach
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Department of Diabetes and Angiology, Marienkrankenhaus, Soest, Germany
| | - Gerhard Rümenapf
- Upper Rhine Vascular Center Speyer-Mahnheim, Diakonissen-Stiftungs-Krankenhaus, Speyer, Germany
| | - Tatjana Kvitkina
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ) Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Heiko Friedel
- Team Gesundheit, Gesellschaft für Gesundheitsmanagement mbH, Essen, Germany
| | | | - Ingrid Schubert
- PMV-Research Group, Department for Child and Adolescent Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Walter Ullrich
- BARMER GEK, Head Quarters, Product Development/Health Care Management, Team Medical Analysis/Health Care Programs, Wuppertal, Germany
| | - Benjamin Westerhoff
- BARMER GEK, Head Quarters, Product Development/Health Care Management, Team Medical Analysis/Health Care Programs, Wuppertal, Germany
| | - Adrian Wilk
- Team Gesundheit, Gesellschaft für Gesundheitsmanagement mbH, Essen, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ) Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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Bächle C, Claessen H, Maier W, Tamayo T, Schunk M, Rückert-Eheberg IM, Holle R, Meisinger C, Moebus S, Jöckel KH, Schipf S, Völzke H, Hartwig S, Kluttig A, Kroll L, Linnenkamp U, Icks A. Regional differences in antihyperglycemic medication are not explained by individual socioeconomic status, regional deprivation, and regional health care services. Observational results from the German DIAB-CORE consortium. PLoS One 2018; 13:e0191559. [PMID: 29370228 PMCID: PMC5784961 DOI: 10.1371/journal.pone.0191559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/08/2018] [Indexed: 11/19/2022] Open
Abstract
AIMS This population-based study sought to extend knowledge on factors explaining regional differences in type 2 diabetes mellitus medication patterns in Germany. METHODS Individual baseline and follow-up data from four regional population-based German cohort studies (SHIP [northeast], CARLA [east], HNR [west], KORA [south]) conducted between 1997 and 2010 were pooled and merged with both data on regional deprivation and regional health care services. To analyze regional differences in any or newer anti-hyperglycemic medication, medication prevalence ratios (PRs) were estimated using multivariable Poisson regression models with a robust error variance adjusted gradually for individual and regional variables. RESULTS The study population consisted of 1,437 people aged 45 to 74 years at baseline, (corresponding to 49 to 83 years at follow-up) with self-reported type 2 diabetes. The prevalence of receiving any anti-hyperglycemic medication was 16% higher in KORA (PR 1.16 [1.08-1.25]), 10% higher in CARLA (1.10 [1.01-1.18]), and 7% higher in SHIP (PR 1.07 [1.00-1.15]) than in HNR. The prevalence of receiving newer anti-hyperglycemic medication was 49% higher in KORA (1.49 [1.09-2.05]), 41% higher in CARLA (1.41 [1.02-1.96]) and 1% higher in SHIP (1.01 [0.72-1.41]) than in HNR, respectively. After gradual adjustment for individual variables, regional deprivation and health care services, the effects only changed slightly. CONCLUSIONS Neither comprehensive individual factors including socioeconomic status nor regional deprivation or indicators of regional health care services were able to sufficiently explain regional differences in anti-hyperglycemic treatment in Germany. To understand the underlying causes, further research is needed.
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Affiliation(s)
- Christina Bächle
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Heiner Claessen
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Werner Maier
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Teresa Tamayo
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Michaela Schunk
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Ina-Maria Rückert-Eheberg
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Rolf Holle
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Christa Meisinger
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Susanne Moebus
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Germany
| | - Sabine Schipf
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Saskia Hartwig
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexander Kluttig
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Lars Kroll
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Ute Linnenkamp
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Park S, Choi D, Kim M, Cha W, Kim C, Moon IC. Identifying prescription patterns with a topic model of diseases and medications. J Biomed Inform 2017; 75:35-47. [PMID: 28958484 DOI: 10.1016/j.jbi.2017.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 11/26/2022]
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Tam ZY, Ng SP, Tan LQ, Lin CH, Rothenbacher D, Klenk J, Boehm BO. Metabolite profiling in identifying metabolic biomarkers in older people with late-onset type 2 diabetes mellitus. Sci Rep 2017; 7:4392. [PMID: 28663594 PMCID: PMC5491522 DOI: 10.1038/s41598-017-01735-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/30/2017] [Indexed: 12/31/2022] Open
Abstract
Regulation of blood glucose requires precise coordination between different endocrine systems and multiple organs. Type 2 diabetes mellitus (T2D) arises from a dysregulated response to elevated glucose levels in the circulation. Globally, the prevalence of T2D has increased dramatically in all age groups. T2D in older adults is associated with higher mortality and reduced functional status, leading to higher rate of institutionalization. Despite the potential healthcare challenges associated with the presence of T2D in the elderly, the pathogenesis and phenotype of late-onset T2D is not well studied. Here we applied untargeted metabolite profiling of urine samples from people with and without late-onset T2D using ultra-performance liquid-chromatography mass-spectrometry (UPLC-MS) to identify urinary biomarkers for late-onset T2D in the elderly. Statistical modeling of measurements and thorough validation of structural assignment using liquid chromatography tandem mass-spectrometry (LC-MS/MS) have led to the identification of metabolite biomarkers associated with late-onset T2D. Lower levels of phenylalanine, acetylhistidine, and cyclic adenosine monophosphate (cAMP) were found in urine samples of T2D subjects validated with commercial standards. Elevated levels of 5′-methylthioadenosine (MTA), which previously has only been implicated in animal model of diabetes, was found in urine of older people with T2D.
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Affiliation(s)
- Zhi Yang Tam
- Singapore Phenome Center, Experimental Medicine Building, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore
| | - Sean Pin Ng
- Singapore Phenome Center, Experimental Medicine Building, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore
| | - Ling Qiao Tan
- Singapore Phenome Center, Experimental Medicine Building, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore
| | - Chih-Hsien Lin
- Singapore Phenome Center, Experimental Medicine Building, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstrasse 22, 89081, Ulm, Germany
| | - Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstrasse 22, 89081, Ulm, Germany.,Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Bernhard Otto Boehm
- Singapore Phenome Center, Experimental Medicine Building, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore. .,Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, UK. .,Department of Internal Medicine I, Ulm University Medical Centre, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
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10
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Kim MH, Jung-Choi K, Ko H, Song YM. Educational Inequality in Obesity-Related Mortality in Korea. J Korean Med Sci 2017; 32:386-392. [PMID: 28145639 PMCID: PMC5290095 DOI: 10.3346/jkms.2017.32.3.386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 12/04/2016] [Indexed: 01/09/2023] Open
Abstract
The prevalence of obesity has been increasing worldwide, which raises concerns about the disease burden associated with obesity. Socioeconomic status (SES) has been suggested to be associated with obesity and obesity related diseases. This study aimed to evaluate the time trend in socioeconomic inequality in obesity-related mortality over the last decade in Korean population. We evaluated the influence of education level, as an indicator of SES, on obesity-related mortality using death data from the Cause of Death Statistics and the Korean Population and Housing Census databases. The rate ratio of the mortality of people at the lowest education level as compared with those at the highest education level (relative index of inequality [RII]) was estimated using Poisson regression analysis. Between 2001 and 2011, RII (95% confidence interval) for overall obesity-related disease mortality increased from 2.10 (2.02-2.19) to 6.50 (6.19-6.82) in men, and from 1.94 (1.79-2.10) to 3.25 (3.05-3.45) in women, respectively. Cause-specifically, the same trend in RII was found for cardiovascular mortality and mortality from diabetes mellitus, whereas the RII of mortality from obesity-related cancers in men did not show the similar trend. Subgroup analysis stratified by age revealed that the RII of obesity-related mortality was much higher in younger people than in older people. In conclusion, there has been persistent socioeconomic inequality in obesity-related mortality in Korea, which was more evident in younger people than in older people and has been deepened over the last decade especially for cardiovascular disease and diabetes.
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Affiliation(s)
- Mi Hyun Kim
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyunghee Jung-Choi
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyeonyoung Ko
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Mi Song
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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11
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Hankins M, Tsai K, Kim J, Hammar N. Early drug use of dapagliflozin prescribed by general practitioners and diabetologists in Germany. Diabetes Res Clin Pract 2017; 125:29-38. [PMID: 28131071 DOI: 10.1016/j.diabres.2016.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/12/2016] [Accepted: 10/30/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Dapagliflozin is an inhibitor of the human sodium-glucose co-transporter 2 (SGLT2) that has been shown to improve glycaemic control in patients with type 2 diabetes mellitus (T2DM). This study aimed to evaluate the characteristics and treatment patterns of dapagliflozin users in comparison to users of other anti-diabetic (AD) treatments in Germany. METHODS Data from patients with T2DM initiating at least one prescription for dapagliflozin or other AD therapy between November 2012 and April 2014 were collected from the IMS German Disease Analyzer database. RESULTS The use of dapagliflozin combination therapy (n=1034; 74%) was more common than monotherapy (n=371; 26%). In comparison with other AD therapy users, a higher percentage of dapagliflozin users were ⩽64years of age (62.3% vs. 36.4%), and a higher proportion were male (59.1% vs. 53.6%). The average duration of diabetes was comparable between dapagliflozin patients and other AD therapy users (5.7yearsvs. 5.5years), however higher levels of HbA1c were found in dapagliflozin users (8.2% (66mmol/mol) vs. 7.5% (58mmol/mol). For the vast majority (71.5% of 10mg dapagliflozin users and 88.9% of 5mg users), dapagliflozin was prescribed in combination with other AD therapy. CONCLUSIONS Patients starting on dapagliflozin differed in several demographic and health-related respects to patients starting another AD therapy during the same period. Dapagliflozin was predominantly used as a component of combination therapy, adding on to existing therapy. After initiation, switching to other AD treatments or adding to therapy was comparatively rare during the first year.
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Affiliation(s)
- Matthew Hankins
- Real World Evidence Solutions, QuintilesIMS, London, UK; Institute of Pharmaceutical Science, King's College, London.
| | - Katherine Tsai
- Medical Evidence & Observational Research, Global Medical Affairs, AstraZeneca, Gaithersburg, USA
| | - Joseph Kim
- Real World Evidence Solutions, QuintilesIMS, London, UK; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London
| | - Niklas Hammar
- Medical Evidence & Observational Research, Global Medical Affairs, AstraZeneca, Mölndal, Sweden; Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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12
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Klein J, von dem Knesebeck O. [Social disparities in outpatient and inpatient care: An overview of current findings in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:238-44. [PMID: 26631009 DOI: 10.1007/s00103-015-2283-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
There is controversy about social disparities in healthcare services in Germany, but a differentiated analysis regarding various dimensions of healthcare is lacking. This narrative review intends to summarize conceptually the current state of research and draw subsequent conclusions. Separated into access, utilization and quality, the findings of social inequality in outpatient and inpatient care in Germany are summarized. Besides the common individual indicators of socioeconomic status (SES), regional deprivation and health insurance status are also included. Despite methodical diversity, the results show that healthcare inequalities due to SES exist, but not universally. Furthermore, there is a differentiated pattern respecting separate dimensions of healthcare. Concerning access (e.g. waiting times, co-payments) lower status groups and patients covered by statutory health insurance are deprived. Higher utilization becomes apparent among higher status groups and privately insured patients in terms of specialist consultations and prevention services. The findings regarding quality of process and outcome differ depending on quality indicator and disease. In different dimensions of medical healthcare, social disparities still exist, though the impact on health remains unclear for some types of healthcare inequalities. Moreover, it is often difficult to conclude from unequal outcome quality the inequalities of healthcare. Depending on access, utilization and quality, separate interventions for reducing these disparities are to be introduced.
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Affiliation(s)
- Jens Klein
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20146, Hamburg, Deutschland.
| | - Olaf von dem Knesebeck
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20146, Hamburg, Deutschland
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13
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Jacob L, von Vultee C, Kostev K. Prescription Patterns and the Cost of Antihyperglycemic Drugs in Patients With Type 2 Diabetes Mellitus in Germany. J Diabetes Sci Technol 2017; 11:123-127. [PMID: 27402240 PMCID: PMC5375068 DOI: 10.1177/1932296816658746] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS The goals were to analyze prescription patterns and the cost of antihyperglycemic drugs in patients with type 2 diabetes (T2DM) treated in Germany in 2015. METHODS This study included 36382 patients aged 40 years or over treated in general practices (GPs) and diabetologist practices who were diagnosed with T2DM in 2015. Nine different families of antihyperglycemic therapy were included in the analysis. Demographic data included age, gender, and type of health insurance coverage. Clinical data included HbA1c level, body mass index (BMI), and the number of T2DM complications. The annual antihyperglycemic treatment cost per patient was calculated based on pharmacy retail prices. The multivariate regression analysis was fitted to estimate the adjusted treatment cost differences. RESULTS The percentage of T2DM patients receiving antihyperglycemic treatments was 87.6. This share was slightly higher in men than in women (89.1% vs 86.0%). Interestingly, the share of people treated with antihyperglycemic drugs decreased with age yet increased with HbA1c levels, BMI, and the number of complications. The average annual cost of antihyperglycemic drugs amounted to €498. It was significantly higher in men than in women (difference of €22). It was also significantly higher in individuals with private health insurance coverage than in people with public health insurance coverage (difference of €153). The annual cost decreased with age. It is compelling to note that this cost increased with HbA1c levels and BMI. Finally, the annual cost also increased with the number of complications. CONCLUSIONS The share and the cost of antihyperglycemic treatments vary with gender, age, type of health insurance coverage, HbA1c levels, BMI, and the number of complications.
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Affiliation(s)
- Louis Jacob
- Department of Biology, École Normale Supérieure de Lyon, Lyon, France
| | | | - Karel Kostev
- IMS Health, Frankfurt, Germany
- Karel Kostev, DMSc, PhD, IMS Health, Epidemiology, Darmstädter Landstraße 1089, 60598 Frankfurt am Main, Germany.
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14
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Laxy M, Knoll G, Schunk M, Meisinger C, Huth C, Holle R. Quality of Diabetes Care in Germany Improved from 2000 to 2007 to 2014, but Improvements Diminished since 2007. Evidence from the Population-Based KORA Studies. PLoS One 2016; 11:e0164704. [PMID: 27749939 PMCID: PMC5066975 DOI: 10.1371/journal.pone.0164704] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/29/2016] [Indexed: 11/23/2022] Open
Abstract
Objective Little is known about the development of the quality of diabetes care in Germany. The aim of this study is to analyze time trends in patient self-management, physician-delivered care, medication, risk factor control, complications and quality of life from 2000 to 2014. Methods Analyses are based on data from individuals with type 2 diabetes of the population-based KORA S4 (1999–2001, n = 150), F4 (2006–2008, n = 203), FF4 (2013/14, n = 212) cohort study. Information on patient self-management, physician-delivered care, medication, risk factor control and quality of life were assessed in standardized questionnaires and examinations. The 10-year coronary heart disease (CHD) risk was calculated using the UKPDS risk engine. Time trends were analyzed using multivariable linear and logistic regression models adjusted for age, sex, education, diabetes duration, and history of cardiovascular disease. Results From 2000 to 2014 the proportion of participants with type 2 diabetes receiving oral antidiabetic/cardio-protective medication and of those reaching treatment goals for glycemic control (HbA1c<7%, 60% to 71%, p = 0.09), blood pressure (<140/80 mmHg, 25% to 69%, p<0.001) and LDL cholesterol (<2.6 mmol/l, 13% to 27%, p<0.001) increased significantly. However, improvements were generally smaller from 2007 to 2014 than from 2000 to 2007. Modeled 10-year CHD risk decreased from 30% in 2000 to 24% in 2007 to 19% in 2014 (p<0.01). From 2007 to 2014, the prevalence of microvascular complications decreased and quality of life increased, but no improvements were observed for the majority of indicators of self-management. Conclusion Despite improvements, medication and risk factor control has remained suboptimal. The flattening of improvements and deteriorations in quality of (self-) care since 2007 indicate that more effort is needed to improve quality of care and patient self-management. Due to selection or lead time bias an overestimation of quality of care improvements cannot be ruled out.
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Affiliation(s)
- Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- * E-mail:
| | - Gabriella Knoll
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Medical Informatics, Biometrics and Epidemiology, Ludwig-Maximilians- Universität München, Munich, Germany
| | - Michaela Schunk
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Christa Meisinger
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany
| | - Cornelia Huth
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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15
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Zhang N, McNeil E, Assanangkornchai S, Fan Y. Hospital and patient influencing factors of treatment schemes given to type 2 diabetes mellitus inpatients in Inner Mongolia, China. F1000Res 2016; 5:1577. [PMID: 27429746 PMCID: PMC4943291 DOI: 10.12688/f1000research.9095.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 11/20/2022] Open
Abstract
Background: In clinical practice, the physician’s treatment decision making is influenced by many factors besides the patient’s clinical conditions and is the fundamental cause of healthcare inequity and discrimination in healthcare settings. Type 2 diabetes mellitus (T2DM) is a chronic disease with high prevalence, long average length of stay and high hospitalization rate. Although the treatment of T2DM is well guideline driven, there is a large body of evidence showing the existence of treatment disparities. More empirical studies from the provider side are needed to determine if non-clinical factors influence physician’s treatment choices. Objective: To determine the hospital and patient influencing factors of treatment schemes given to T2DM inpatients in Inner Mongolia, China. Methods: A cross-sectional, hospital-based survey using a cluster sampling technique was conducted in three tertiary hospitals and three county hospitals in Inner Mongolia, China. Treatment schemes were categorized as lifestyle management, oral therapy or insulin therapy according to the national guideline. Socio-demographic characteristics and variables related to severity of disease at the individual level and hospital level were collected. Weighted multinomial logistic regression models were used to determine influencing factors of treatment schemes. Results: Regardless of patients’ clinical conditions and health insurance types, both hospital and patient level variables were associated with treatment schemes. Males were more likely to be given oral therapy (RRR=1.72, 95% CI=1.06-2.81) and insulin therapy (RRR=1.94, 95% CI=1.29-2.91) compared to females who were given lifestyle management more frequently. Compared to the western region, hospitals in the central regions of Inner Mongolia were less likely to prescribe T2DM patients oral therapy (RRR = 0.18, 95% CI=0.05-0.61) and insulin therapy (RRR = 0.20, 95% CI=0.06-0.67) than lifestyle management. Compared with non-reformed tertiary hospitals, reformed tertiary hospitals and county hospitals were less likely to give T2DM patients oral therapy (RRR = 0.07 and 0.1 respectively) and insulin therapy (RRR = 0.11 and 0.17 respectively). Conclusion: Gender was the only socio-demographic factors associated with treatment scheme for T2DM patients. Hospitals from different regions have different T2DM treatment patterns. Implementation of reform was shown to be associated with controlling medication use for T2DM inpatients. Further studies are needed to investigate the causes of unreasonable treatment disparities so that policies can be generated accordingly.
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Affiliation(s)
- Nan Zhang
- School of Health Management, Inner Mongolia Medical University, Inner Mongolia, China
| | - Edward McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Yancun Fan
- School of Health Management, Inner Mongolia Medical University, Inner Mongolia, China
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16
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Qiao Q, Grandy S, Hiller J, Kostev K. Clinical and Patient-Related Variables Associated with Initiating GLP-1 Receptor Agonist Therapy in Type 2 Diabetes Patients in Primary Care in Germany. PLoS One 2016; 11:e0152281. [PMID: 27019360 PMCID: PMC4809528 DOI: 10.1371/journal.pone.0152281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 03/12/2016] [Indexed: 12/22/2022] Open
Abstract
Aims To investigate real-world clinical and patient-related variables associated with initiating GLP-1 receptor agonist (GLP-1RA) treatment relative to initiation of other glucose-lowering therapies in type 2 diabetes (T2D) patients of primary care in Germany. Methods Data for 938 T2D patients who started therapy with a GLP-1RA within 823 practices of primary care throughout Germany were retrospectively analyzed (Disease Analyser: 01/2011–03/2014). 5,197 T2D patients who initiated other non-GLP-1RA antidiabetic therapies were selected as controls. Multivariate logistic regression analyses were applied to identify factors associated with GLP-1RA initiation in primary care. Results Mean age (SD) of GLP-1RA users was 57.8 (11.8) years (males: 55.5%) and the average BMI was 36.1 (6.7) kg/m2. 22.8% were in diabetologist care and 12.0% had private health insurance. In multivariate regression, choice of GLP-1RA therapy instead of a different glucose-lowering drug class was associated with obesity (odds ratio: 1.68; 95% CI: 1.34–2.10), private health insurance (2.42; 1.89–3.09), younger age (0.94; 0.93–0.95 per year), male sex (0.85; 0.73–0.99), diabetologist care (2.11; 1.73–2.57), and geographic practice location (East vs. West-Germany; 1.25; 1.05–1.49). Among co-medication, angiotensin II antagonists (increased) and non-steroidal antirheumatic agents (decreased) were related to GLP-1RA prescriptions (both p<0.001). Conclusions Consistent with German guidelines, GLP-1RA is mainly prescribed preferentially in T2D patients who are obese. GLP-1RA drugs were more frequently used than other options in privately health insured patients and in patients seeing a diabetologist.
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Affiliation(s)
- Qing Qiao
- AstraZeneca, Global Medicines Development, Mölndal, Sweden
| | - Susan Grandy
- AstraZeneca, Global Medicines Development, Gaithersburg, Maryland, United States of America
| | - Josh Hiller
- IMS Health, Real World Evidence Solutions, London, United Kingdom
| | - Karel Kostev
- IMS Health, Epidemiology, Frankfurt am Main, Germany
- * E-mail:
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Bächle C, Claessen H, Andrich S, Brüne M, Dintsios CM, Slomiany U, Roggenbuck U, Jöckel KH, Moebus S, Icks A. Direct costs in impaired glucose regulation: results from the population-based Heinz Nixdorf Recall study. BMJ Open Diabetes Res Care 2016; 4:e000172. [PMID: 27252871 PMCID: PMC4885277 DOI: 10.1136/bmjdrc-2015-000172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/01/2016] [Accepted: 03/10/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE For the first time, this population-based study sought to analyze healthcare utilization and associated costs in people with normal fasting glycemia (NFG), impaired fasting glycemia (IFG), as well as previously undetected diabetes and previously diagnosed diabetes linking data from the prospective German Heinz Nixdorf Recall (HNR) study with individual claims data from German statutory health insurances. RESEARCH DESIGN AND METHODS A total of 1709 participants of the HNR 5-year follow-up (mean age (SD) 64.9 (7.5) years, 44.5% men) were included in the study. Age-standardized and sex-standardized healthcare utilization and associated costs (reported as € for the year 2008, perspective of the statutory health insurance) were stratified by diabetes stage defined by the participants' self-report and fasting plasma glucose values. Cost ratios (CRs) were estimated using two-part regression models, adjusting for age, sex, sociodemographic variables and comorbidity. RESULTS The mean total direct healthcare costs for previously diagnosed diabetes, previously undetected diabetes, IFG, and NFG were €2761 (95% CI 2378 to 3268), €2210 (1483 to 4279), €2035 (1732 to 2486) and €1810 (1634 to 2035), respectively. Corresponding age-adjusted and sex-adjusted CRs were 1.53 (1.30 to 1.80), 1.16 (0.91 to 1.47), and 1.09 (0.95 to 1.25) (reference: NFG). Inpatient, outpatient and medication costs varied in order between people with IFG and those with previously undetected diabetes. CONCLUSIONS The study provides claims-based detailed cost data in well-defined glucose metabolism subgroups. CRs of individuals with IFG and previously undetected diabetes were surprisingly low. Data are important for the model-based evaluation of screening programs and interventions that are aimed either to prevent diabetes onset or to improve diabetes therapy as well.
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Affiliation(s)
- C Bächle
- Paul Langerhans Group of Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - H Claessen
- Paul Langerhans Group of Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - S Andrich
- Paul Langerhans Group of Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Germany; Department of Public Health, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - M Brüne
- Paul Langerhans Group of Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - C M Dintsios
- German Center for Diabetes Research (DZD), Neuherberg, Germany; Department of Public Health, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - U Slomiany
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen , Germany
| | - U Roggenbuck
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen , Germany
| | - K H Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen , Germany
| | - S Moebus
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen , Germany
| | - A Icks
- Paul Langerhans Group of Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany; Department of Public Health, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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18
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Baumeister SE, Schomerus G, Andersen RM, Tost F, Markus MRP, Völzke H, Jürgens C. Trends of barriers to eye care among adults with diagnosed diabetes in Germany, 1997-2012. Nutr Metab Cardiovasc Dis 2015; 25:906-915. [PMID: 26298427 DOI: 10.1016/j.numecd.2015.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/09/2015] [Accepted: 07/13/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS To study trends of barriers to receiving recommended eye care among subjects with diabetes aged 20-81 years in northeast Germany. METHODS AND RESULTS We analyzed population-based data from two repeated cross-sectional surveys conducted in 1997-2001 and 2008-2012 (Ns of 4308 and 4402). Andersen's Behavioral Model of Health Services Utilization was used to identify individual-level demographic, financial and health-related barriers to annual eye-care utilization in subjects with a self-reported physician's diabetes and to examine population trends in these barriers. The prevalence of diabetes increased from 6.5% to 11.4%. The prevalence of annual eye-care utilization among persons with diabetes decreased from 69.4% to 56.0% (adjusted relative risk = 0.77, p < 0.001). The decline of eye care utilization over the past decade in eye-care use was more pronounced in groups at risk for diabetes-related complications (i.e., lower socio-economic status, >5 years since diagnosis of diabetes, poor glycemic control, obesity, smoking, lack of physical activity, co-existing diseases). We identified relevant predictors of missed annual eye-care use among diabetics. CONCLUSION The increase of diabetes prevalence and downward trend of eye-care visits at the recommended level call for development, implementation and evaluation of continued efforts to improve access to eye specialists, particularly among those with poor diabetic control, co-existing diabetic complications, and comorbidities.
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Affiliation(s)
- S E Baumeister
- Institute of Epidemiology and Preventive Medicine, University of Regensburg, Germany; Institute for Community Medicine, University Medicine Greifswald, Germany.
| | - G Schomerus
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Germany; Helios Hanseklinikum, Stralsund, Germany
| | - R M Andersen
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, USA
| | - F Tost
- Department of Ophthalmology, University Medicine Greifswald, Germany
| | - M R P Markus
- Institute for Community Medicine, University Medicine Greifswald, Germany; Department of Internal Medicine B, University Medicine Greifswald, Germany
| | - H Völzke
- Institute for Community Medicine, University Medicine Greifswald, Germany
| | - C Jürgens
- Institute for Community Medicine, University Medicine Greifswald, Germany
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