Implementation of the National Guidelines for the treatment of Diabetes mellitus type 2 in secondary diabetes centers].

Background The German National Disease Management Guideline (NVL) on treatment of Type 2 Diabetes recommends lowering of blood glucose in four therapy steps. There is little evidence, how NVL is implemented for the individual patients. Methods 810 patients in secondary diabetes centers were examined within the DiabCheckOCTplus trial. Data about the patient's health status (electronic medical record) were classified according to the NVL treatment steps. The degree of implementation was assessed for every person with diabetes type 2 (NCT02 311 504). Results Related to the levels of treatment, 81 % of patients received metformin in level 2, 48 % the dual combination of metformin with DPP4-Inhibitors (level 3) and 41 % an intensified insulin therapy in combination with metformin (level 4). The overall percentage for metformin was 67 %, for DPP4-Inhibitors 20 % and 10 % for sulfonylureas.The duration of diabetes significantly increased with higher NVL level. After 3 years of diabetes 55 % received more than one antihyperglycemic drug. Half of the patients were treated with complex insulin strategies after 9 years, however almost all after 25 years. Conclusion The therapy in secondary care centers met national guidelines to a large extent. Similar proof of implementation would be important for primary care by general practitioners. As the factual information of the therapy level strongly correlated with the duration of disease, it might be used for structured communication (risk profile). © Georg Thieme Verlag KG Stuttgart · New York.

Citation

Lydia Marahrens, Daniel Röck, Tjalf Ziemssen, Raimar Kern, Focke Ziemssen, Andreas Fritsche. Implementation of the National Guidelines for the treatment of Diabetes mellitus type 2 in secondary diabetes centers]. Deutsche medizinische Wochenschrift (1946). 2017 Sep;142(18):e131-e139

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PMID: 28902377

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