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

Guidelines for the optimal management - valid equally for every country in the European

Union

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

Results

P=NS

106,84

30,17

HbA1c

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%

Macrovascular complications of diabetes

5%

Health education, training sessions

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

Thank you for your kind attention!