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

How do patients with diabetes report their comorbidity? Comparison with administrative data

Jonas Hoffmann,1,* Burkhard Haastert,2,* Manuela Br&uuml;ne,1 Matthias Kaltheuner,3 Alexander Begun,1 Nadja Chernyak,4 Andrea Icks1,4,5 1Institute of Health Services Research and Health Economics, German Diabetes Center, D&uuml;sseldorf, Germany; 2mediStatistica, Neuenrade, Germany; 3Specialized Diabetes Practice Leverkusen, Leverkusen, Germany; 4Faculty of Medicine, Centre for Health and Society, Institute of Health Services Research and Health Economics, Heinrich-Heine University D&uuml;sseldorf, D&uuml;sseldorf, Germany; 5German Center for Diabetes Research, Ingolst&auml;dter Neuherberg, Germany *These authors contributed equally to this work Aims: Patients with diabetes are probably often unaware of their comorbidities. We estimated agreement between self-reported comorbidities and administrative data. Methods: In a random sample of 464 diabetes patients, data from a questionnaire asking about the presence of 14 comorbidities closely related to diabetes were individually linked with statutory health insurance data. Results: Specificities were &gt;97%, except cardiac insufficiency (94.5%), eye diseases (93.8%), peripheral arterial disease (92.6%), hypertension (90.9%), and peripheral neuropathy (85.8%). Sensitivities were &lt;60%, except amputation (100%), hypertension (83.1%), and myocardial infarction (67.2%). A few positive predictive values were &gt;90% (hypertension, myocardial infarction, and eye disease), and six were below 70%. Six negative predictive values were &gt;90%, and two &lt;70% (hypertension and eye disease). Total agreement was between 42.7% (eye disease) and 100% (dialysis and amputation). Overall, substantial agreement was observed for three morbidities (kappa 0.61&ndash;0.80: hypertension, myocardial infarction, and amputation). Moderate agreement (kappa 0.41&ndash;0.60) was estimated for angina pectoris, heart failure, stroke, peripheral neuropathy, and kidney disease. Factors associated with agreement were the number of comorbidities, diabetes duration, age, sex, and education. Conclusions: Myocardial infarction and amputation were well reported by patients as comorbidities; eye diseases and foot ulceration rather poorly, particularly in older, male, or less educated patients. Patient information needs improving. Keywords: diabetes comorbidities, self-report, agreement, patient informatio

Regional differences in type 2 diabetes treatment and outcomes in Germany-An analysis of the German DPV and DIVE registries.

Aims On the basis of the Diabetes Versorgungs-Evaluation (DIVE) and Diabetes-Patienten-Verlaufsdokumentation (DPV) datasets, we aimed to explore the impact of differences in treatment modalities on outcomes in Germany and put these into a global context. Methods Results The 2014 to 2016 DIVE and DPV databases were combined, and a total of 127 838 patients 18 years and older was analysed with respect to demographics, cardiovascular risk factors, comorbidities, treatments, and outcomes, separately for each German state. Estimates were expressed as adjusted least squares means together with 95% confidence intervals. Saarland dataset recorded the lowest mean HbA(1c) (6.7%; 6.6%-6.8%; 50 mmol/mol, 49-51 mmol/mol), Saxony-Anhalt showed the highest (8.3%; 8.2%-8.3%; 67 mmol/mol, 66-67 mmol/mol). The highest percentage of hypoglycaemic events was reported in Mecklenburg-West Pomerania (MWP) (4.7%; 3.9%-5.7%), the lowest in Thuringia (0.9%; 0.2%-3.4%). Metformin and sulfonylurea accounted for 36.4% to 53.3% of anti-diabetic treatments across states; other antihyperglycaemic drugs such as DPP-4 inhibitors, SGLT2 inhibitors, and GLP-1 analogues were used most often in MWP (40.0%; 37.8%-42.1%) and least in Rhineland-Palatinate (13.6%; 13.0%-14.2%). Treatment with insulin (alone or in combination) was reported most often in MWP (78.2%; 76.4%-80.0%) and least in Thuringia (26.0%; 20.1%-32.9%). Conclusions Federal states in Germany are heterogeneous concerning diabetes treatment and associated outcomes. These data should stimulate further discussion about how optimal diabetes care can be implemented in all areas of Germany, to achieve good treatment outcomes in all federal states

Welche Patienten aus der Routinebetreuung verwenden das neue Insulin-Analogon Glargin U300 im Vergleich zu Patienten mit Glargin U100? Eine multizentrische Analyse von 14.123 Patienten mit Insulin Glargin aus den Diabetesregistern DPV und DIVE. &nbsp;

Summary: Background: Glargine U300 (Gla-300) is a further development of glargine U100 (Gla-100). Since 2015, Gla-300 has been available in Germany and Austria. We compared patients initiating therapy with Gla-300 with patients starting with Gla-100. Moreover, it was investigated whether patients from real-life diabetes care differ from patients participating in the EDITION clinical study program. Summary: Methods: Data are based on the diabetes registries DPV and DIVE. Patients started/switched to Gla-100 or Gla-300 in 2015 were included. Linear regression was applied for bodyweight (BW), BMI, HbA 1C , daily total and basal insulin dose/kgBW and negative binomial regression for severe hypoglycemia. Data were adjusted for age, sex, and diabetes duration. Summary: Results: 14,123 patients were identified (Gla-100: 11,397; Gla-300: 2726). Gla-300 patients with T1D were older, T2D patients younger compared to subjects using Gla-100 (both p &lt; 0.0001). In Gla-300 subjects, diabetes duration was longer (both p &lt; 0.0001). Patients started/switched to Gla-300 had a higher BW, a higher BMI and a lower baseline HbA 1C . The rate of severe hypoglycemia was comparable. Total and basal insulin doses/kgBW were higher in patients with Gla-300. Summary: DPV/DIVE subjects were older, had a lower BW, and were more frequently male compared to EDITION patients. HbA 1C was higher in T1D patients from DPV/DIVE. Summary: Conclusion: Data from the diabetes registries DPV/DIVE indicate differences between Gla-300 and Gla-100 patients at the onset of insulin therapy. This analysis provides additional information to the EDITION clinical study program

Gestational Diabetes Mellitus (GDM) - Diagnosis, Treatment and Follow-Up. Guideline of the DDG and DGGG (S3 Level, AWMF Registry Number 057/008, February 2018).

A team of experts from the fields of gynaecology and obstetrics, diabetology, internal medicine, paediatrics and midwifery from Germany, Austria and Switzerland produced a new version of the existing S3 guideline on gestational diabetes. It replaces the recommendations of the German Association for Gynaecology and Obstetrics and the German Diabetes Association on the diagnosis and treatment of gestational diabetes from 2011 and is valid for the three German-speaking countries. The primary aim of the guideline is to improve and standardise the prevention, screening, diagnosis, treatment and follow-up of gestational diabetes through evidence-based recommendations for the outpatient and inpatient area. A large number of new studies and data published in the last few years required a comprehensive revision of the 2011 guideline. The new aspects include early screening of pregnant women with a high risk for diabetes or gestational diabetes, the validity of two-stage screening in the third trimester by means of the 50-g challenge test, as specified in the maternity guidelines, use of metformin instead of or in addition to insulin in gestational diabetes, and birth planning with GDM and/or macrosomia. The recommendations are based on the evidence from the literature, which was selected through a systematic external literature search. All recommendations had to pass through a consensus process. The present text corresponds to the practice guideline on gestational diabetes, which is an action-oriented short version of the evidence-based S3 guideline that can be viewed on the internet

Suboptimale Diabetesakzeptanz ist mit einer schlechteren Diabetes-Selbstbehandlung und darüber mit einer schlechteren glykämischen Kontrolle assoziiert: Eine Mediationsanalyse

Die klinische Bedeutung von Diabetesakzeptanz ist bisher nicht eindeutig geklärt. In dieser Studie wurde untersucht, in welcher Weise Diabetesakzeptanz mit Selbstbehandlungsverhalten und glykämischer Kontrolle assoziiert ist - unabhängig von Diabetesbelastung und Depressivität

Correction: Gestational diabetes mellitus (GDM), diagnostics, therapy and follow-up care.

This erratum is being published to remove the authors Vladimir Patchev and Monika Nothacker