management of diabetes mellitus and its complications – comparative study - between a romanian and...
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Management of diabetes mellitus and its complications – comparative study - between a Romanian and a German
Diabetes Care Center
Author: Feier IngridCoordinator: Dr. Szabó Mónika
Background• In 2013 382 million people worldwide
have diabetes (IDF), 592 million in 2035
• 7. leading cause of death in the world in 2030 (WHO)
• Leading cause of blindness, amputation and kidney failure (WHO)
• The organization of diabetes care is crucial in the management
Management of diabetes - similarities -
1.HbA1c: • Measurement frequency - at least 2 times each year in patients who are meeting treatment targets and have stable
glycemic control - quarterly in patients whose therapy has changed or who are not meeting glycemic targets• Value - < 7 %
2.Visit frequencies: - 3-4 times/year
3.Complication screening - 3-4 times/year
4.Coverage of diabetes care and medication - For free
Management of diabetes - differences -
Romania Germany
Structure of Diabetes Care Center
1 doctor+1 assistant/1600 patients
1 doctor+2 diabetes educators+2 diabetes-assistants+2 „wound-assistant“/1400 patients
Structured education - Individual, group education/training sessions
Test coverage 100 tests/3 months for patients treated with insulin
OAD (insulinotrop):50 tests/3 monthsInsulin:ICT: 400 tests/3 monthsCT: 200 tests/3 monthsBOT: 100 tests/3 months
Financial background of the patients
lower higher
Objective
• To investigate the differences and their consequences in diabetes management in a Romanian and German Day Care Center
Material and Method• Patients suffering from type 2 diabetes: 100 from Târgu Mures, Romania
100 from Mülheim, Germany
• We compared following parameters:Glycated hemoglobinBody mass indexWaist circumferenceDiabetic polyneuropathy, retinopathy, nephropathyStroke, coronary heart disease (CHD)Health education, training sessions
Microvascular complications of diabetes
0%
10%
20%
30%
40%
50%
60%
70%
80%
Polyneuropathy (p=0,008)
Retinopathy (p=0,000)
Nephropathy (p=0,009)
German
Romanian28%
73%
22%
54%
7% 8%
Conclusions• No significant differences concerning HbA1c, waist circumference,
BMI
• The prevalence of microvascular complications (polyneuropathy, retinopathy, nephropathy) in the Romanian group was significantly higher
inadequate training and monitoring of HbA1c (HbA1c was measured 3 times more frequently in the German group)
• Macrovascular complications: Stroke -> same prevalence in both groups, CHD (coronary heart disease ) -> significantlyhigher in the Romanian group
• Importance of diabetes educators/ assistants