Validierung eines Fragebogens zu Problemen der Krankheitsakzeptanz bei Diabetes mellitus: Diabetes Acceptance Scale (DAS)

Fragestellung: Probleme der Diabetesakzeptanz sind assoziiert mit non-adhärentem Selbstbehandlungsverhalten und hyperglykämischer Blutzuckereinstellung. Zur Erfassung von Diabetesakzeptanzproblemen existierte bisher allerdings nur ein recht limitiertes Messinstrument, der Acceptance and Action Diabetes Questionnaire (AADQ). Um differenziertere Messungen zu ermöglichen, wurde die Diabetes Acceptance Scale (DAS) entwickelt, deren Validierung hier berichtet wird. Methodik: Die DAS ist eine 28-Item-Selbstberichtsskala mit Subskalen zur diabetesbezogenen „Akzeptanz/Integration“, „Behandlungsmotivation“, „Abwehr/Vermeidung“ und „emotionalen Belastung“ sowie einer Summenskala zur Gesamt-Diabetesakzeptanz; Entwicklung beschrieben in Diabetologie und Stoffwechsel 2015; 10 – P137. 460 Diabetespatienten (50% Typ-1, 48% Typ-2, 2% Typ-3; 50% weiblich; Alter 52 ± 15 Jahre; BMI 30 ± 7 kg/m2; Diabetesdauer 15 ± 12 Jahre; HbA1c 7,8 ± 1,4%) bearbeiteten die DAS sowie Fragebögen zu Diabetesakzeptanzproblemen (AADQ), diabetesbezogener Belastung (PAID-5), depressiver Stimmung (PHQ-9) und Diabetes-Selbstbehandlungsverhalten (DSMQ). Gleichzeitig wurde der HbA1c-Wert bestimmt. Anhand dieser Daten wurden Kennwerte der Reliabilität (Cronbachs α) und Validität (kriterienbezogene Korrelationen) der DAS untersucht. Ergebnisse: Alle DAS-Skalen zeigten durchweg hohe Reliabilität (Subskalen: α= 0,89 – 0,93; Summenskala: α= 0,96). Höhere DAS-Summenwerte (bessere Diabetesakzeptanz) waren hoch korreliert mit weniger Diabetesakzeptanzproblemen nach AADQ (r=-0,65), geringerer diabetesbezogener Belastung (r=-0,69) und weniger Depressivität (r=-0,56); alle P< 0,001. Weiter korrelierten höhere DAS-Summenwerte mit günstigeren Selbstbehandlungsverhaltensweisen nach DSMQ (diabetesgerechte Ernährung: r= 0,56; Medikamentenadhärenz: r= 0,54; Blutzuckerselbstkontrolle: r= 0,42; körperliche Betätigung: r= 0,26; Arztkontakt: r= 0,51) sowie einer besseren Blutzuckereinstellung (HbA1c-Wert: r=-0,42); alle P< 0,001. Schlussfolgerungen: Die Ergebnisse sprechen für eine hohe Reliabilität und Validität der Diabetes Acceptance Scale. Die Skala erscheint als sehr gutes Messinstrument zur Erkennung von Problemen der Diabetesakzeptanz sowie zur besseren Erforschung dieser gravierenden psychologischen Problematik

Blood glucose testing and primary prevention of diabetes mellitus type 2 - evaluation of the effect of evidence based patient information

<p>Abstract</p> <p>Background</p> <p>Evidence-based patient information (EBPI) has been recognised as important tool for informed choice in particular in the matter of preventive options. An objective, on the best scientific evidence-based consumer information about subthreshold elevated blood glucose levels (impaired fasting glucose and impaired glucose tolerance) and primary prevention of diabetes, is not available yet. Thus we developed a web-based EBPI and aim to evaluate its effects on informed decision making in people 50 years or older.</p> <p>Methods/Design</p> <p>We conduct a web-based randomised-controlled trial to evaluate the effect of information about elevated blood glucose levels and diabetes primary prevention on five specific outcomes: (i) knowledge of elevated blood glucose level-related issues (primary outcome); (ii) attitudes to a metabolic testing; (iii) intention to undergo a metabolic testing; (iv) decision conflict; (v) satisfaction with the information. The intervention group receives a specially developed EBPI about subthreshold elevated blood glucose levels and diabetes primary prevention, the control group information about this topic, available in the internet.</p> <p>The study population consists of people between 50 and 69 years of age without known diabetes. Participants will be recruited via the internet page of the cooperating health insurance company, Techniker Krankenkasse (TK), and the internet page of the German Diabetes Centre. Outcomes will be measured through online questionnaires. We expect better informed participants in the intervention group.</p> <p>Discussion</p> <p>The design of this study may be a prototype for other web-based prevention information and their evaluation.</p> <p>Trial registration</p> <p>Current Controlled Trial: ISRCTN22060616.</p

Within-trial economic evaluation of diabetes-specific cognitive behaviour therapy in patients with type 2 diabetes and subthreshold depression

<p>Abstract</p> <p>Background</p> <p>Despite the high prevalence of subthreshold depression in patients with type 2 diabetes, evidence on cost-effectiveness of different therapy options for these patients is currently lacking.</p> <p>Methods/Design</p> <p>Within-trial economic evaluation of the diabetes-specific cognitive behaviour therapy for subthreshold depression. Patients with diabetes and subthreshold depression are randomly assigned to either 2 weeks of diabetes-specific cognitive behaviour group therapy (n = 104) or to standard diabetes education programme only (n = 104). Patients are followed for 12 months. During this period data on total health sector costs, patient costs and societal productivity costs are collected in addition to clinical data. Health related quality of life (the SF-36 and the EQ-5D) is measured at baseline, immediately after the intervention, at 6 and at 12 months after the intervention. Quality adjusted life years (QALYs), and cumulative costs will be estimated for each arm of the trial. Cost-effectiveness of the diabetes-specific cognitive behaviour group therapy will be analysed from the perspective of the German statutory health insurance and from the societal perspective. To this end, incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained will be calculated.</p> <p>Discussion</p> <p>Some methodological issues of the described economic evaluation are discussed.</p> <p>Trial registration</p> <p>The trial has been registered at the Clinical Trials Register (NCT01009138).</p

Effizienzbewertung im Rahmen des GKV-Versorgungsstärkungsgesetzes: Was kann die Gesundheitsökonomie hierzu beitragen?

Mit dem GKV-Versorgungsstärkungsgesetz erhielt der Gemeinsame Bundesausschuss den Auftrag, neue Versorgungsformen und -forschungsprojekte zu fördern. Als Förderkriterien werden u.a. die Versorgungseffizienz und die Verhältnismäßigkeit von Implementierungskosten und dem damit verbundenen Nutzen genannt. Für die Versorgungsforschung bedeutet dies, dass auch gesundheitsökonomische Studien nun an Relevanz gewinnen. Dabei wirken der sozialrechtlich verankerte ordnungspolitische Rahmen über das Wirtschaftlichkeitsgebot und die Beitragssatzstabilität als Determinanten der Effizienzbewertung. Allerdings ist die Evaluation komplexer Interventionen wie neue Versorgungsformen auch mit entsprechenden methodischen Herausforderungen verknüpft. Die aktuellen nationalen und internationalen Studienbeispiele zu komplexen Interventionen verdeutlichen das Potenzial und den Beitrag der gesundheitsökonomischen Disziplin zur Effizienzsteigerung in der Versorgung.   Evaluating Efficiency within the Act to improve the health care structures in the SHI: What can Health Economics contribute to it? With the “Act to improve the health care structures in the SHI” the Federal Joint Committee was commissioned to promote new forms of health care and health services research projects. As eligibility criteria for funding, among others, the efficiency of health care delivery and the appropriateness of implementation costs and benefit were defined. Thus, the relevance of health economic studies becomes obvious for health services research. Basic principles of efficiency and the stability of contribution rates embedded in German social law determine the regulatory framework for the assessment of efficiency. While the evaluation of complex interventions such as new forms of health care provision is accompanied by methodical challenges, the potential for and contribution of health economics to improving the efficiency of health care could be demonstrated in recent national and international applications. JEL-Klassifizierung: I10, I18, I1

Treatment pattern of type 2 diabetes differs in two German regions and with patients' socioeconomic position

BACKGROUND: Diabetes treatment may differ by region and patients' socioeconomic position. This may be particularly true for newer drugs. However, data are highly limited. METHODS: We examined pooled individual data of two population-based German studies, KORA F4 (Cooperative Health Research in the Region of Augsburg, south), and the HNR (Heinz Nixdorf Recall study, west) both carried out 2006 to 2008. To ascertain the association between region and educational level with anti-hyperglycemic medication we fitted poisson regression models with robust error variance for any and newer anti-hyperglycemic medication, adjusting for age, sex, diabetes duration, BMI, cardiovascular disease, lifestyle, and insurance status. RESULTS: The examined sample comprised 662 participants with self-reported type 2 diabetes (KORA F4: 83 women, 111 men; HNR: 183 women, 285 men). The probability to receive any anti-hyperglycemic drug as well as to be treated with newer anti-hyperglycemic drugs such as insulin analogues, thiazolidinediones, or glinides was significantly increased in southern compared to western Germany (prevalence ratio (PR); 95% CI: 1.12; 1.02-1.22, 1.52;1.10-2.11 respectively). Individuals with lower educational level tended to receive anti-hyperglycemic drugs more likely than their better educated counterparts (PR; 95% CI univariable: 1.10; 0.99-1.22; fully adjusted: 1.10; 0.98-1.23). In contrast, lower education was associated with a lower estimated probability to receive newer drugs among those with any anti-hyperglycemic drugs (PR low vs. high education: 0.66; 0.48-0.91; fully adjusted: 0.68; 0.47-0.996). CONCLUSIONS: We found regional and individual social disparities in overall and newer anti-hyperglycemic medication which were not explained by other confounders. Further research is needed

Hospitalization in pediatric diabetes : a nationwide analysis of all admission causes for Germany in 2015

Introduction Regarding pediatric diabetes, hospital admission for acute complications of type 1 diabetes (T1D) has often been investigated, but little is known about other causes of hospitalization. This study aimed to explore the total burden of hospitalization in individuals with diabetes <20 years of age in Germany. Methods Using the German Diagnosis-Related Groups data for 2015, we examined the frequencies of hospitalization with diabetes (20,251 inpatient cases), stratified by diabetes type [T1D, type 2 diabetes (T2D), other specified diabetes types (T3D), and unclear diabetes], and without diabetes (1,269,631 inpatient cases). Using estimates of the population at risk with T1D, T2D, and without diabetes, we evaluated hospitalization rates (per patient-year) by Poisson regression. For T1D, T2D, and T3D, we investigated the most frequent diagnoses and the median length of stay. Most analyses were stratified by sex, age-group and east/west residence. Results Children and adolescents with diabetes had a 6 to 9 times higher hospitalization risk than peers without diabetes (hospitalization rate 0.09). The hospitalization rate was higher for T2D compared with T1D (0.84 vs. 0.53, P<0.001). In T2D, two-third of inpatient cases were not directly related to diabetes, and stay was shorter compared with T1D and T3D (3 vs. 4 and 5 days, respectively). In T1D, hospitalization was more frequent among girls than boys (0.58 vs. 0.49, P<0.001), and mostly due to “diabetes without complications” (65.7%). Hospitalization tended to be more frequent and longer in the youngest patients, and in those with east residence. Conclusion Hospitalization rate in pediatric diabetes in Germany remained high, especially for T2D patients, girls with T1D, and young children