Disease management program for type 1 diabetes in Germany
Disease management programs (DMPs) are structured treatment programs that aim to improve the management of chronic illnesses. They include regular doctor’s appointments with consultations and check-ups, as well as patient education and self-help advice. Doctors who provide treatment as part of a DMP have to fulfill certain requirements and follow defined quality standards.
The disease management program for type 1 diabetes in Germany includes the following:
- Development of an individual treatment plan together with the doctor
- Patient education programs
- Medical check-ups
- Advice for smokers
- Structured review of medications
- The prevention and treatment of accompanying diseases and consequences of diabetes
The treatment offered in DMPs is usually carried out by various doctors who are specialized in different areas. It is coordinated by a diabetes specialist (diabetologist), or sometimes by the person’s family doctor. His or her job will include things like planning the treatment, referring the patient to other specialists, or making arrangements for rehabilitation treatment.
Individual treatment plan
The aim of treatment for type 1 diabetes is to improve quality of life, prevent long-term consequences of the disease, and increase life expectancy.
In the DMP for type 1 diabetes, the main goals of treatment are
- to prevent damage to the eyes and kidneys,
- to avoid nerve damage (neuropathy) and relieve already existing nerve-related problems (especially pain),
- to prevent the development of diabetic foot syndrome and the need for amputations,
- to lower the risk of cardiovascular (heart and blood vessel) disease, and
- to avoid hyperglycemia and hypoglycemia (high and low blood sugar).
At the beginning of the DMP, the exact treatments are planned together with the coordinating doctor. The type of treatments will depend on various factors, including how likely the diabetes is to have harmful consequences – or in some cases, to what extent they have already occurred. The existence of certain accompanying diseases and life circumstances will play an important role too.
Patient education programs
The most important medication for the treatment of type 1 diabetes is insulin. A key part of the treatment is therefore to learn how to use insulin and measure your blood sugar properly. This is taught in special patient education programs, where patients also learn how to adjust their diet and lifestyle in order to optimize the treatment outcomes.
They also receive a lot of information about their illness and how to manage diabetes in everyday life.
People who participate in the DMP have the following regular examinations:
|Adults||Children and teenagers|
|Blood tests and urine tests to detect kidney damage early on||Once a year (after having diabetes for five years)||Once a year (from the age of ten, or at the latest after having diabetes for five years)|
|Eye examination to look at the retina||Once every one to two years (after having diabetes for five years)||Once every one to two years (from the age of ten, or at the latest after having diabetes for five years)|
|Foot examination to look for nerve damage and problems with blood circulation||At least once a year|
|If the patient has a higher risk: Foot examination and footwear inspection||Four times a year|
|Blood pressure measurement||One to four times per year||At least once a year (from the age of eleven)|
|HbA1c measurement||Two to four times per year||Two to four times per year|
|Inspection of injection sites||Two to four times per year (or more frequently if blood sugar levels fluctuate a lot)||Two to four times per year (or more frequently if blood sugar levels fluctuate a lot)|
Advice for smokers
As part of the DMP, doctors inform patients about the risks of smoking and passive smoking for people with type 1 diabetes. They regularly ask the patient about their smoking habits, motivate them to stop smoking, and give them information about things that can help kick the habit.
Review of medications
People who already have medical conditions associated with, or caused by, diabetes usually take a lot of medications. Doctors should then pay particular attention to the side effects and interactions between the medications. If someone regularly takes more than five different medications, their medication use is reviewed at least once a year as part of the DMP. Products like dietary supplements are also considered to be medications here, even if they aren’t prescribed by a doctor.
The review of medications involves checking whether the medications need to be combined in a different way, whether the doses need to be adjusted, and whether the person can stop taking any of them.
The doctor makes sure that the list of all the medications and medicinal products that the person is taking is always up-to-date.
The prevention and treatment of accompanying diseases and long-term consequences
If type 1 diabetes has already led to the development of other medical conditions, particular attention is paid to the treatment of those conditions as part of the DMP. Doctors with different areas of specialization work together here.
If someone has diabetic kidney disease (nephropathy), it can make sense for them to be treated by a kidney specialist, also known as a nephrologist. Changes in kidney function can be monitored by doing regular blood and urine tests. Medication can be used to try to keep the kidneys working properly for as long as possible. In more advanced kidney disease, dialysis or a kidney transplant may be needed.
People who have diabetic eye disease (retinopathy) have various treatment options, including medication and surgery. The aim of treatment is to slow down the progression of eye damage and prevent loss of vision.
Diabetic nerve damage (neuropathy) can be treated with medication.
Doctors offer advice about measures for the prevention of diabetic foot syndrome (“diabetic foot“) – ranging from regularly measuring your own blood sugar levels, to taking good care of your feet, to wearing the right kind of shoes. Already existing or advanced diabetic foot syndrome can be treated in specialized doctor’s practices or clinics. Regular foot care can be carried out by podiatrists (foot care specialists). The person’s shoes should also be altered by an orthopedic specialist.
To reduce the risk of cardiovascular disease, both the blood sugar levels and high blood pressure need to be treated. Cholesterol-lowering medication and “blood thinners” can be taken to lower the risk of diseases affecting the blood vessels.
As part of the DMP, the doctors should also assess whether the person may benefit from psychological help – for instance, if they have an eating disorder or depression.
If a woman is planning to become pregnant, or is already pregnant, she is offered a special consultation to discuss how to reduce the risks to her and her child.
Children and teenagers who participate in the DMP receive treatment that takes their specific needs into account. Their families are involved in the treatment process, but there is also a focus on helping them to be as independent as possible.
Gemeinsamer Bundesausschuss (G-BA). Richtlinie des Gemeinsamen Bundesausschusses zur Zusammenführung der Anforderungen an strukturierte Behandlungsprogramme nach §137f Abs. 2 SGB V (DMP-Anforderungen-Richtlinie/DMP-A-RL). April 20, 2017.
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