Development of diabetes complications within coordinated and structured primary health care: a 10-year retrospective cohort study in Germany

Abstract

BackgroundDiabetes mellitus is a growing, costly, and potentially preventable public health issue. In 2004, Germany introduced the GP-centred healthcare programme to strengthen primary care.AimTo assess the hazards of the most common diabetes-related complications in patients enrolled in GP-centred health care in comparison with usual primary care.Design & settingA retrospective cohort study based on German claims data (4 million members) from 2011–2020.MethodIn total, 217 964 patients with diabetes were monitored from 2011–2020. Endpoints were blindness, amputation, myocardial infarction, stroke, coronary heart disease, dialysis, hypoglycaemia, and all-cause mortality. Cox proportional-hazards regression models were used for multivariable analysis and adjusted for sociodemographic, practice, and disease-specific characteristics.ResultsCompared with usual care (n= 98 609 patients), GP-centred health care (n= 119 355 patients) showed a relative risk reduction of blindness of 12%, and amputation of 20% over 10 years. The estimated impact of GP-centred health care on myocardial infarction, stroke, coronary artery disease, dialysis, and all-cause mortality is significantly favourable in comparison with usual care. However, the proportional risk of hypoglycaemia (+1.2%) in the interventional group is higher than in usual care.ConclusionEnrolment in GP-centred health care appears to result in a consistent reduction of the relative risk of diabetes-related complications over 10 years. The significant difference in contrast to usual care may be explained by robust, structured primary care provision, including the diabetes disease management programme, and improved coordination and networking of care within primary and secondary care.