Quality of diabetes care in patients living in a rural area of Germany

Patient and method: In a population-based study the quality of diabetes car e of insulin-treated diabetic patients aged 16 to 60 years and living in a rural area was studied. The parameters of metabolic control as well as the incidence of acute complications (severe hypoglycemia with the need of gluc ose or glucagon injection, ketoacidosis with hospital admission) were asses sed by examination and with a standardized questionnaire in 81% of the targ et population (type-1/type-2-diabetic patients: n = 25/33). Also, in all th e patients diabetic long-term complications (retinopathy, nephropathy, ampu tations of the lower extremities) were examined. 76% of the patients with t ype-1-diabetes and 91% of the patients with type-2-diabetes mellitus comple ted standardized questionnaires to assess quality of life and treatment sat isfaction. Results: In type-1-diabetic patients HbA1c was 9.38 +/- 1.6%. In type-2-dia betic patients it was 9.53 +/- 1.91%. None of the patients examined was reg ularly treated by a specialized physician/diabetologist. The goal of metabo lic control, a HbA1c value below 7.2%, was reached only by 4% of the patien ts with type-1- and 12% of the patients with type-2-diabetes mellitus. In m ultivariate analysis the most important factor associated with HbA1c was in type-1-diabetic patients female sex (R-squared = 0.27, c = 0.38, p = 0.059 ); in patients with type-2-diabetes mellitus it was the number of insulin i njections per day (R-squared = 0.37, c = 0.19, p = 0.0096). All other facto rs investigated in the model (diabetes duration, insulin dosage/kg body wei ght, frequency of blood- or urine-glucose self-monitoring/week, body mass i ndex, educational level) showed no significant associations. Quality of lif e and treatment satisfaction of the patients were good and comparable to ot her trials. Conclusion: Out of other studies there is evidence for better metabolic con trol in patients regularly treated by specialized physicians/diabetologists and in patients who participated in structured treatment and teaching prog rams. These features must be the main goals of treatment for all patients w ith diabetes mellitus.