Diabetes Mellitus in German Primary Care: Quality of Glycaemic Control and Subpopulations not well Controlled – Results of the DETECT Study

Abstract

Introduction: The quality of glycaemic control of patients with T1D and T2D can be assessed with HbA_1c levels. We aimed to assess the quality of glycaemic control and the prevalence of inadequately controlled diabetes in German primary care, and to determine simple patient and treatment related factors associated with poor control.

Material and Methods: Using a nationwide probability sample of 3 188 general practices (response rate 50.6%), a total of 55,518 patients were assessed in DETECT, a cross-sectional and prospective multistage epidemiological study. Diabetes diagnoses were based on physician assessment. HbA_1c values were taken from the patient charts.

Results: The quality of metabolic control was unsatisfactory on the whole in the 277 people with T1D (e.g. mean HbA_1c=7.4%±1.4%). The 8 188 people with T2D had a mean HbA_1c of 6.89%±1.2%. 38.8% of individuals had an HbA_1c≥7.0%. The situation was less favourable in subjects with a longer history of diabetes – in many cases in those with diabetes for 5–9 years, but generally in those with a plus-10-year history of diabetes – and also in younger men with a shorter disease history. Patients with a short T2D history, especially older subjects had more favourable values. With regard to age, a higher percentage of patients had an HbA_1c≥7.0% (42.0% and 40.6%) in the 45–54 and 55–64 year olds. With respect to the correlation between HbA_1c and treatment modality, we identified the best metabolic control in T2D patients without drug therapy for diabetes, and the worst in patients on combination regimens (OAD/insulin). The average duration of diabetes in the various treatment groups differs substantially. The average duration was highest (12.1 y) in the insulin group. Oral treatment was the predominant treatment modality in all HbA_1c categories.

Conclusion: T1D treatment needs to be improved overall. The situation as regards T2D is less clear-cut. When people with T2D start requiring more intensive and complex treatment in response to disease progression, the treatment efforts of patients and physicians evidently fail to keep up with the actual pace of metabolic deterioration. Early and strict alignment with approximately normal HbA_1c targets is essential. Close attention should be paid to T2 diabetics with a 5–9-year diabetes history, with the aim of preventing any loss of metabolic control. Likewise, patients aged 45–64 y and younger men require more attention.

Key words

type 1 diabetes - type 2 diabetes - epidemiology - quality of glycaemic control - mean HbA_1c - frequency of HbA_1c≥7.0% - treatment modalities - primary care - cross sectional study

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