Aims/hypothesis
The aim of this study was to identify the health care costs of diabetic patients in Germany in 2001, focusing on the influence of age, sex, and type of treatment.

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The cost burden of diabetes mellitus: the evidence from Germany—the CoDiM Study

OBJECTIVE: To estimate the impact of type 1 diabetes during pregnancy on transgenerational genetically caused and/or fuel-mediated amplification of types 1 and 2 diabetes and to estimate the impact of elevated amniotic fluid insulin levels. RESEARCH DESIGN AND METHODS: A total of 75 white offspring of type 1 diabetic mothers and 49 control subjects of similar age and pubertal stage were examined at 5-15 years of age. All offspring had an oral glucose tolerance test. Glucose, insulin, and C-peptide were measured at 0, 30, 60, and 120 min after loading. Lipids and autoimmune antibodies were measured in fasting plasma. RESULTS: Of the 75 offspring, 4 (5.3%) had overt diabetes, and 16 of 71 (22.5%) had autoimmune antibodies. Offspring of diabetic mothers had significantly higher BMI; symmetry indexes; cholesterol, glucose, insulin, and C-peptide levels; and insulin resistance than control subjects. With the exception of cholesterol, these values were significantly elevated in offspring who had elevated amniotic fluid insulin levels (>8 microU/ml, >48 pmol/l) during pregnancy compared with normoinsulinemic offspring and control subjects. CONCLUSIONS: Offspring of type 1 diabetic mothers have an increased risk for diabetes later in life. The relative risk for type 1 and type 2 diabetes is 71.6 and 3.2, respectively. Type 2 diabetes-associated risk factors, such as high BMI; elevated glucose, insulin, and C-peptide levels; and insulin resistance, are related to the fetal metabolic experience in utero, as reflected by amniotic fluid insulin concentration.

https://care.diabetesjournals.org/content/diacare/23/7/905.full.pdf

Long-term follow-up of infants of mothers with type 1 diabetes: evidence for hereditary and nonhereditary transmission of diabetes and precursors.

Objective This population-based study assesses the prevalence and cost of illness as a result of diabetes mellitus in Germany by retrospectively analysing routine health insurance data. Prevalence and costs were analysed from statutory health insurance (GKV) and societal perspectives.



Research design and methods  The analysis comprises data of all insured persons of six large sickness funds. The insured with diabetes were identified via ICD-9 diagnosis and Anatomical Therapeutic Chemical Classification System (ATC) code for regular medication prescriptions. Costs for inpatient stay, medication and sickness benefits were taken from claims data. Costs for rehabilitation, premature death and early retirement were calculated using the human capital approach and data from national statistics.



Results  Overall diabetes prevalence in this age and sex standardized census of six large sickness funds was 6.45%. The cost of illness for sickness funds including hospital cost, medication and sickness benefits, and excluding ambulatory doctor care, were €3.69bn. The total cost of diabetes from a societal perspective was calculated at €5.71bn for the year 1999.



Conclusion  In accordance with the results of recent studies using routinely collected health insurance data, our study suggests that the prevalence of diabetes mellitus has increased steadily in the past years. The prevalence in our population of 14.7 million insured was 6.45%. Total costs of diabetes mellitus amounted to €5.71bn.

Diabetes--prevalence and cost of illness in Germany: a study evaluating data from the statutory health insurance in Germany.

than the rest of the population of the Registre de Malats Renals de Catalunya. These observations call Purpose of study. In recent years, a progressive increase in the need of renal replacement therapy has been for the institution of primary or secondary prevention. noted for patients with diabetes mellitus. The present report is based on an analysis of the data of the renal registry; renal replacement therapy ‘Registre de Malats Renals de Catalunya’ (RMRC ). It was the aim to identify (i) the incidence and prevalence of diabetic patients on renal replacement therapy, (ii) associated diseases, (iii) the relative risk of diVerent Introduction modes of treatment, and (iv) the rate of death compared to non-diabetic patients on renal replacement Diabetic nephropathy (DN ) is a microangiopathic therapy and in the general population. complication which has a major impact on the health Results. Of the 936 diabetic patients starting renal system and which aZicts more than one-third of replacement therapy during the period 1984‐1994, patients with insulin-dependent diabetes (IDDM ) [1] 24.8% were classified as DN and IDDM, 65.7% as DN and a less well defined proportion (~20%) of diaand NIDDM, and in 9.5%, diabetes accompanied renal betic patients with non-insulin-dependent diabetes failure from standard primary renal disease. The incid- (NIDDM ) [2]. Once DN has set in, it will inexorably ence of diabetic patients has increased from 3 per progress to end-stage renal failure [3], at least without million population (pmp) in 1984 to 26.6 pmp in 1994. treatment. Its very presence is a major risk factor for At any given age the risk of requiring renal replacement cardiovascular death [4]. This fact explains why mortherapy with diabetes was 1.5-fold higher in males than bidity and mortality in patients with DN is higher than in females. Of diabetic patients who were 50% (RRT ) [5]. lived with a simultaneous kidney/pancreas graft. For The proportion of the types of diabetes varies diabetic patients above this age, haemodialysis was the according to genetic background and geography [6 ]. most prevalent form of treatment. Morbidity in dia- In Northern Europe and in the UK, DN in patients betic patients was higher than in the overall RMRC with IDDM is more frequent than in other countries population. Cardiac and vascular disease were the [7]. In contrast, in Central and Southern Europe, the most prominent complications. Mortality of diabetic overwhelming majority of uraemic patients reaching patients on renal replacement therapy was twice that end-stage renal failure suVer from NIDDM which of the overall population of RMRC and 16-fold higher appears to predominate particularly in Mediterranean than in the general population of Catalunya. The risk countries [8]. of death increased with age and was higher in patients In the recent past, the majority of registries docuwith reduced functional autonomy. Transplanted mented a progressive increase of diabetic patients on patients had a smaller risk than patients on haemodia- RRT. The magnitude of this increase varies, being lysis or CAPD. Survival has increased for patients highest in USA, Japan and Scandinavia, where DN starting treatment after 1990 compared to the period has become the most frequent cause of end-stage renal 1984‐1989.

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Diabetic patients on renal replacement therapy: analysis of Catalan Registry data. Renal Registry Committee.

Necrobiosis lipoidica (NL) is a rare granulomatous disorder of unknown etiology which can manifest in ulcerative skin lesions and is widely recognised in association with diabetes mellitus. Our aim was to improve knowledge about the epidemiology and clinical course of NL and evaluate treatment approaches. This multicentre retrospective study covered data from 52 patients with NL of the lower leg, treated between 2006 and 2011. Data from three German dermatological centres were analysed. Twelve men and 40 women, aged 15 to 87 years, were evaluated with regard to epidemiological data, ulcerations, co-morbidities, laboratory values and treatment options. NL was significantly more frequent in women (76.9%). Ulceration of NL was observed in 25% of all patients and in 37.5% with concomitant diabetes mellitus. 88% received topical treatment with corticosteroids, 56% compression therapy of the lower legs, 42% UV-phototherapy and 29% topical calcineurininhibitors. Systemic therapies were also used occasionally. Our data indicate that female sex, middle age and endocrine disorders like diabetes mellitus are characteristics of NL patients. As new aspects, we found an accumulation of thyroidal dysfunction (13%) and that ulcerations are predominantly in males (58%). Associations with co-morbidities may become clearer in prospective studies of larger cohorts. Topical steroids, calcineurin inhibitors, compression therapy and phototherapy seem to be the basis therapies although our evaluation showed that standardized guidelines are missing. More experimental therapeutic options, like biologicals, photodynamic therapy or the use of fumaric acid esters, should be assessed for efficacy and safety by large, randomized, controlled trials.

Update on clinical and laboratory features in necrobiosis lipoidica: a retrospective multicentre study of 52 patients

De nos jours, les donnees concernant la prevalence du diabete en Allemagne ne peuvent etre obtenues qu'en s'adressant aux societes d'assurance maladie. Le Registre National du Diabete de l'ex-RDA (Allemagne de l'Est), qui a enregistre environ 98% de tous les diabetiques, est un outil permettant de verifier les evaluations epidemiologiques provenant d'autres sources de donnees. En consequence, nous avons compare les bases de donnees suivantes: (1) un echantillon randomise de 5% de toutes les personnes (n=6478) assurees par une societe d'assurance maladie imposee par la loi dans la ville de Dortmund; (2) des donnees analogues obtenues a partir du registre de la population diabetique de l'ex-Berlin Est, et (3) les donnees de l'ex-RDA

H. Thoelke

Papers

Diabetes prevalence from health insurance data: evaluation of estimates by comparison with a population-based diabetes register.