Self-perceived oral health of people with and without diabetes mellitus: results of the study GEDA 2019/2020-EHIS

Background: Self-perceived oral health reflects the individual’s point of view. Both subjective (e.g. pain, aesthetic aspects) and objective criteria (e.g. oral diseases, functional limitations) are included in the assessment. Oral diseases interact with noncommunicable diseases such as diabetes mellitus. Method: Data basis is the study German Health Update (GEDA 2019/2020-EHIS). In the telephone interview, respondents were asked about the presence of diabetes in the last 12 months and the state of their teeth and gums. Prevalences, prevalence ratios (PR) and p-values from Poisson regressions were calculated for people aged 18 years and older (N = 22,613). Results: People with diabetes were more likely to rate their oral health as fair to very poor than people without diabetes (41.2 % vs. 27.5 %). The association between diabetes and fair to very poor self-perceived oral health persisted after statistical control for sociodemographic and behavioural characteristics (PR 1.22, p < 0.001). This applies to both women and men. Discussion: Based on a population-representative sample, it was shown for the first time for Germany that there is an association between diabetes and oral health in adulthood. These results support international research findings. Greater interdisciplinary cooperation between physician groups who treat people with diabetes and dentists is required.Peer Reviewe

which marker is best for prediction? Pooled analysis of four German population-based cohort studies and comparison with a nationwide cohort study

Objective To compare the association between different anthropometric measurements and incident type 2 diabetes mellitus (T2DM) and to assess their predictive ability in different regions of Germany. Methods Data of 10 258 participants from 4 prospective population-based cohorts were pooled to assess the association of body weight, body mass index (BMI), waist circumference (WC), waist-to-hip-ratio (WHR) and waist-to-height-ratio (WHtR) with incident T2DM by calculating HRs of the crude, adjusted and standardised markers, as well as providing receiver operator characteristic (ROC) curves. Differences between HRs and ROCs for the different anthropometric markers were calculated to compare their predictive ability. In addition, data of 3105 participants from the nationwide survey were analysed separately using the same methods to provide a nationally representative comparison. Results Strong associations were found for each anthropometric marker and incidence of T2DM. Among the standardised anthropometric measures, we found the strongest effect on incident T2DM for WC and WHtR in the pooled sample (HR for 1 SD difference in WC 1.97, 95% CI 1.75 to 2.22, HR for WHtR 1.93, 95% CI 1.71 to 2.17 in women) and in female DEGS participants (HR for WC 2.24, 95% CI 1.91 to 2.63, HR for WHtR 2.10, 95% CI 1.81 to 2.44), whereas the strongest association in men was found for WHR among DEGS participants (HR 2.29, 95% CI 1.89 to 2.78). ROC analysis showed WHtR to be the strongest predictor for incident T2DM. Differences in HR and ROCs between the different markers confirmed WC and WHtR to be the best predictors of incident T2DM. Findings were consistent across study regions and age groups (<65 vs ≥65 years). Conclusions We found stronger associations between anthropometric markers that reflect abdominal obesity (ie, WC and WHtR) and incident T2DM than for BMI and weight. The use of these measurements in risk prediction should be encouraged

Trends in prevalence and number of cases of diagnosed type 2 diabetes in Germany: Projections until 2050

Background: In order to assess the prevention and care needs for type 2 diabetes in the coming decades from a public health perspective, forecasts on the trends in prevalence and case numbers are essential. Methods: The data are based on age-specific estimates of diagnosed diabetes prevalence from the survey German Health Update (GEDA) 2022, and on the proportion of type 2 diabetes derived from routine health insurance data. Using routine data on the incidence and excess mortality of diabetes, various scenarios for the future trends of type 2 diabetes are modelled using an illness-death model. Results: Based on a type 2 diabetes prevalence of 8.6 % in 2022 (women: 8.2 %, men: 9.2 %), corresponding to a total of 6.05 million cases (women: 2.92 million, men 3.13 million), the prevalence is expected to rise to 16.1 % by 2050 (women: 14.8 %, men: 17.4 %), with the number of cases increasing to 11.01 million (women: 5.19 million, men: 5.82 million). Assuming a 2.0 % annual decline in incidence, the prevalence is expected to rise to only 12.2 % (8.39 million cases); with a simultaneous 2.0 % annual decline in excess mortality, the prevalence is expected to reach 13.0 % (8.94 million cases). Conclusions: The prognosis is mainly influenced by changes in incidence. Primary preventive approaches to reduce risk factors for type 2 diabetes are therefore crucial to counteract an increase in the number of type 2 diabetes cases.Peer Reviewe

Self-assessed quality of care among adults with diagnosed diabetes in Germany

People who have diabetes require regular medical care. The views of patients about the quality of their care are becoming increasingly relevant when it comes to chronic diseases such as diabetes. As part of the nationwide study Disease Knowledge and Information Needs – Diabetes mellitus (2017), data on self-assessed quality of care by people with diagnosed diabetes was collected using the Patient Assessment of Chronic Illness Care – DAWN short form (PACIC-DSF, scale 1 to 5) and analysed for respondents aged 45 years or above. The average score for quality of care was 2.47 and was lower for women than for men (2.33 vs 2.58). The respondents assessed the quality of their care as being worse with rising age and size of the population in their residential area. No significant differences were observed by education group. Overall, people with diabetes in Germany consider the quality of their care to be moderate, which indicates a need for improvement in care

Association between random glucose and all-cause mortality: findings from the mortality follow-up of the German National Health Interview and Examination Survey 1998

Background Random glucose is widely measured in epidemiological studies and in the clinical setting when standardized fasting protocols and oral glucose tolerance testing or HbA1c measuring are not feasible. The relationship between random glucose and all-cause mortality has hardly been studied so far and was examined in the present study. Methods We ascertained mortality status among 5955 persons aged 18–79 years and free of known diabetes when participating in the German National Health Interview and Examination Survey 1998 (mean observation time 11.7 years, 458 deaths). Cox regression was applied to analyze the association of random serum glucose with all-cause mortality taken potential confounders into account. Relative mortality risks were estimated as hazard ratios (HRs) with 95% confidence intervals (CIs) modeling random glucose as categorical or continuous variable. Results Compared to random glucose levels of 4.3 - < 5.3 mmol/L, HRs (95% CIs) were 1.94 (0.85–4.45) for levels < 4.3 mmol/L and 1.16 (0.89–1.50), 1.20 (0.91–1.58), 1.42 (0.88–2.29), 2.02 (1.26–3.25) and 4.71 (2.20–10.10) for levels 5.3 - < 5.8, 5.8 - < 6.8, 6.8 - < 7.8, 7.8 - < 11.1 and ≥ 11.1 mmol/L, adjusted for age, sex, lifestyle, anthropometry and chronic diseases. An additional adjustment for fasting time or HbA1c yielded similar estimates. Modeling continuous random glucose by restricted cubic spline functions revealed comparable findings. Conclusions In the present epidemiological study drawn from the general population, random glucose showed a significant association with all-cause mortality, independent of main potential confounders. Thus, random glucose measures are highly relevant to health risk assessment among people without known diabetes when fasting glucose or HbA1c are difficult to obtain.Peer Reviewe

Selbstwahrgenommene Mundgesundheit von Personen mit und ohne Diabetes mellitus: Ergebnisse der Studie GEDA 2019/2020-EHIS

Hintergrund: Die selbstwahrgenommene Mundgesundheit spiegelt die individuelle Sichtweise wider. In die Bewertung gehen subjektive (z. B. Schmerzen, ästhetische Aspekte) wie objektive Kriterien (z. B. orale Krankheiten, Funktionseinschränkungen) ein. Orale Krankheiten stehen in Wechselwirkung mit nichtübertragbaren Erkrankungen wie Diabetes mellitus. Methode: Datenbasis ist die Studie Gesundheit in Deutschland aktuell (GEDA 2019/2020-EHIS). Im telefonischen Interview wurde nach dem Vorliegen eines Diabetes in den letzten 12 Monaten sowie nach dem Zustand von Zähnen und Zahnfleisch gefragt. Berechnet wurden Prävalenzen sowie Prevalence Ratios (PR) und p-Werte aus Poisson-Regressionen bei Personen ab 18 Jahren (N = 22.613). Ergebnisse: Personen mit Diabetes schätzten ihre Mundgesundheit häufiger als mittelmäßig bis sehr schlecht ein als Personen ohne Diabetes (41,2 % vs. 27,5 %). Der Zusammenhang zwischen Diabetes und einer mittelmäßigen bis sehr schlechten selbstwahrgenommenen Mundgesundheit blieb nach statistischer Kontrolle für soziodemografische und verhaltensbezogene Merkmale bestehen (PR 1,22, p < 0,001). Dies trifft auf Frauen sowie Männer zu. Diskussion: Auf Basis einer bevölkerungsrepräsentativen Stichprobe konnte erstmals für Deutschland gezeigt werden, dass ein Zusammenhang zwischen Diabetes und Mundgesundheit im Erwachsenenalter besteht. Die vorliegenden Ergebnisse stützen internationale Forschungsbefunde. Eine stärkere interdisziplinäre Zusammenarbeit zwischen Arztgruppen, die Menschen mit Diabetes behandeln, und Zahnärztinnen und Zahnärzten ist erforderlich.Peer Reviewe

Diabetes surveillance – Laying the groundwork for non-communicable disease surveillance in Germany

Not Peer Reviewe

Non-utilisation of health care services during the COVID-19 pandemic: Results of the CoMoLo study

Based on data from the CORONA-MONITORING lokal (CoMoLo) study conducted in four municipalities particularly affected by the COVID-19 pandemic, this article investigates the non-utilisation of health care services in the population aged 18 years and older (n=9,002) in relation to the period after the introduction of the containment measures in March 2020. The results show that about one third of the respondents (35.5%) gave up at least one of the surveyed health care services. The most frequent cancellations were dental (15.2%) and specialist check-ups (11.8%), followed by postponement of physiotherapy, ergotherapy or speech therapy (6.1%), cancellation of general practitioner (GP) check-ups (5.8%), postponement of psychotherapy (2.0%), postponement of planned hospital treatment (1.8%) and not going to an emergency room (0.7%). Almost 10% of the respondents reported not visiting a physician despite health complaints. Compared to respondents without such a waiver, these respondents were more often female and younger than 35 years, less often rated their health as very good or good, more often had a diagnosis of depression and more often used telemedical contacts as an alternative to visiting the practice during the pandemic. Further analyses of trends in utilisation behaviour and changes in health status over the course of the COVID-19 pandemic are important

Utilisation of outpatient medical services by people with diagnosed diabetes during the COVID-19 pandemic in Germany

People with diabetes regularly need outpatient medical care due to their disease and possible concomitant and secondary illnesses. Using data from the nationwide GEDA 2019/2020-EHIS survey conducted from April 2019 to September 2020, the present study examines developments in outpatient utilisation behaviour during the measures put in place to contain the SARS-CoV-2 pandemic. During the observation period, people with diabetes had a significantly higher rate of utilisation of medical services provided by general practitioners (GPs) and specialists than the population as a whole. In the spring of 2020, when the restrictions were put in place, utilisation of specialist medical services by people with diabetes decreased temporarily by 46% compared to the 2019 reference period. In contrast, no relevant decline in the utilisation of medical services provided by GPs was observed, but this could be related to adaptations of care provision through telephone consultations for people with regularly requiring GP office visits. The issue examined here requires further observations in view of the renewed containment measures

Associations between dietary patterns and biomarkers of nutrient status and cardiovascular risk factors among adolescents in Germany: results of the German Health Interview and Examination Survey for Children and Adolescents in Germany (KiGGS)

Background: The aim of this study is to analyse prevailing dietary patterns among German adolescents and their associations with biomarkers of nutrient status and cardiovascular risk factors. Methods: Analyses were based on data from the nationwide, representative Health Interview and Examination Survey for Children and Adolescents in Germany, conducted between 2003 and 2006 (KiGGS baseline). Dietary habits of 12 to 17 year olds (2646 boys and 2551 girls) were determined using 34 food groups assessed with a food frequency questionnaire. Principal component analysis was applied to determine the major dietary patterns. The associations between dietary patterns and biomarkers were analysed using linear regression analyses. Results: We identified three major dietary patterns among boys and two among girls. Higher scores of the ‘healthy’ patterns (fruits, salad vegetables, wholemeal bread) were associated with higher levels of serum folate and lower levels of homocysteine among both sexes and higher levels of serum vitamin B12 among girls. Conversely, higher scores of the ‘western’ pattern among boys (salty snacks, burger, French fries) were associated with a lower ferritin level and lower diastolic blood pressure. The ‘traditional’ pattern among boys (white bread, processed meat, meat) was associated with a lower folate level and the ‘western and traditional’ pattern among girls (salty snacks, burger, French fries) with lower folate and higher homocysteine levels. No associations between dietary patterns and blood lipids, HbA1c and uric acid were found. The mean age of boys with higher scores in the ‘western’ pattern was higher, whereas the mean age of girls with higher scores in the ‘western and traditional’ dietary patterns was lower. Conclusions: Adolescents with higher scores in the ‘healthy’ dietary patterns had a better nutrient profile. Therefore, healthy dietary patterns should be promoted early in life, with a special focus on the sex differences