DÄ internationalArchive13/2008Prevalence of Diabetes Mellitus and Quality of Care in Hesse, Germany, 1998–2004: In Reply


Prevalence of Diabetes Mellitus and Quality of Care in Hesse, Germany, 1998–2004: In Reply

Dtsch Arztebl Int 2008; 105(13): 238. DOI: 10.3238/arztebl.2008.0238b

Hauner, H

LNSLNS Many thanks for the reader's letter, which is constructive and addresses relevant questions. It is correct that our sample of AOK insurance customers is not representative of the overall population and that a certain amount of bias in the results can therefore not be excluded.

Our analysis is based exclusively on the retrospective evaluation of accounting data and reflects the quality of the process. This means that adherence to therapeutic guidelines can be captured only indirectly. Any particularities inherent in the use or provision of services were not captured by our methodological approach. The observed trends, however, favor the assumption that the billed services have become closer to the established therapeutic guidelines over time. Since we can report only average values, it is entirely possible that a proportion of doctors – especially those with a qualification in diabetology – act in close adherence to the guidelines, whereas another proportion does not really observe the recommendations to a sufficiently high degree. We think it is entirely plausible that the unmistakably positive trend is the result of the improved structures in diabetes care.

Like Dr. Hoß, we were surprised to find no unequivocal decrease in the number of inpatient admissions. The suspicion that many admissions were unnecessary may thus be correct. Another explanation may be that these days, patients with diabetes live longer, thanks to improved care provision. The older the patient, the more difficult it is to resolve therapeutic problems in an outpatient setting. Further, it should not be forgotten that only a minority of diabetes patients receives care in specialist centers for diabetes. This may mean that the potential for better integrated care is high. DOI: 10.3238/arztebl.2008.0238b

Prof. Dr. med. Hans Hauner
Else-Kröner-Fresenius-Zentrum für Ernährungsmedizin
der Technischen Universität München
Klinikum rechts der Isar
Ismaninger Str. 52
81675 München, Germany

Conflict of interest statement
The PMV research group has received unrestricted grants for epidemiological and health economic, non-product related analyses from the following companies: Aventis/Sanofi-Aventis, Pfizer, Lilly, Hoffmann-LaRoche, Janssen-Cilag. Hans Hauner has received honoraria for speaking from Sanofi-Aventis, Lilly, Merck, Novartis, GSK, and travel support from Sanofi-Aventis.