Current Practice of Podiatrists in Testing for Diabetic Polyneuropathy and Implementing Foot Care (PROTECT Study Survey 2).

AIMS: Podiatrists constitute a key member of a multidisciplinary foot care team, but their services remain underutilized. We sought to gain insights into the daily practice of podiatrists focusing on screening for and monitoring of diabetic sensorimotor polyneuropathy (DSPN) as well as foot management. METHODS: This cross-sectional survey included 125 podiatrists from 12 federal states across Germany who responded to an online questionnaire. RESULTS: The majority of patients treated in podiatry practices were referred by general practitioners and diabetologists. Screening for or follow-up of DSPN was performed by 36% of the respondents at least once a year, by 28% only at initial examination, by 21% only at suspicion, and by 10% basically at each treatment visit. Instruments to assess vibration, touch/pressure, and temperature sensation were used by 81% to 94% of the podiatrists. Previously undiagnosed DSPN and foot ulcers were detected frequently/very frequently (≥6 cases/mo) by 24.0 and 18.4% of the podiatrists, respectively. Almost all podiatrists advised daily self-monitoring of feet and appropriate foot care and >50% gave advice on medical treatment. CONCLUSIONS: Podiatrists play an important role in the detection, monitoring, and management of both DSPN and diabetic foot ulcers, suggesting that the utilization of their services should be fostered.

Shared Decision Making, Diagnostic Evaluation, and Pharmacotherapy in Type 2 Diabetes.

BACKGROUND: Type 2 diabetes is one of the most important widespread diseases worldwide. In Germany, nearly one in five persons over age 65 has type 2 diabetes. The German National Disease Management Guideline for Type 2 Diabetes (NDMG; in German: Nationale Versorgungsleitlinie, NVL) contains updated recommendations for the diagnostic evaluation and pharmacotherapy of this disease as well as information about specific groups of people for whom early detection may be useful. METHODS: The guideline has been updated, chapter by chapter, since 2018. Its recommendations are based on systematically searched and evaluated scientific evidence, the clinical expertise of a multidisciplinary panel of experts, and patient perspectives. RESULTS: The new chapter on shared decision making includes a description of a structured approach that can be used when individual treatment goals have not been achieved. The diagnosis of diabetes newly requires at least two abnormally elevated laboratory values: e.g., fasting plasma glucose ≥ 126 mg/dL (≥ 7.0 mmol/L), HbA1c ≥ 6.5 % (≥ 48 mmol/mol) and/or casual plasma glucose ≥ 200 mg/dL (≥ 11.1 mmol/L). Cardiovascular and renal risks are to be considered in the choice of drug. Studies have shown that, in persons with cardiovascular disease, treatment with GLP-1 receptor agonists (GLP-1, glucagon-like peptide-1) or SGLT2 inhibitors (SGLT2, sodium-glucose co-transporter-2) was less likely than the comparison intervention to lead to certain patient-relevant endpoints, including all-cause mortality (OR = 0.88 and 0.84, respectively), hospitalization for heart failure (SGLT2 inhibitors: OR = 0.65), and worsening of renal function (OR = 0.61 and 0.59, respectively). CONCLUSION: Current evidence continues to support the recommendations on pharmacotherapy of the 2021 guideline. The Guideline Group did not find evidence of adequate certainty to inform recommendations about the screening of persons at risk, HbA1c target values, or screening for sequelae and comorbidities. Better evidence on these matters would be desirable.

Diabetes incidence before and after COVID-19 vaccination - Results from the German Disease Analyzer database.

Objective: We investigated whether COVID-19 vaccination had an impact on diabetes risk. Methods: We used data of 6,198 patients (mean age 64.3 years) from the nationwide Disease Analyzer database, a representative panel of physicians' practices in Germany. Patients received their first COVID-19 vaccination between 1 April 2021 and 31 March 2022, and all were newly diagnosed with diabetes within 183 days before or after this vaccination. Incident rates of diabetes after vaccination were compared to incident rates before vaccination. Results: The incidence rate of diabetes was lower after vaccination than before vaccination (incidence rate ratio = 0.79, 95% confidence interval: 0.75-0.83). The number of incident cases of diabetes was not greater in 2021 than in 2019. Conclusion: Our study did not confirm an increased risk of diabetes after COVID-19 vaccination. Further studies are needed to show whether the vaccination may be associated with a reduced diabetes risk.

Routine care for people with newly diagnosed type 2 diabetes before and during the SARS-CoV-2 pandemic - results from the German Disease Analyzer database.

AIM: To investigate whether the SARS-CoV-2 pandemic affected care for people with newly diagnosed type 2 diabetes in Germany. METHODS: The Disease Analyzer database (IQVIA, Germany) contains routine data on diagnoses and treatments (ICD-10 and ATC codes) from patients followed in selected physician practices across Germany. We compared 21,747 individuals with a first diagnosis of type 2 diabetes between January 2018 and September 2019 with 20,513 individuals with a first diabetes diagnosis between March 2020 and November 2021. RESULTS: In March and April 2020, the number of new diagnoses of diabetes decreased by 18.3% and 35.7%, respectively, compared to March and April of the previous two years. The previous diabetes incidence level was reached again in June 2020. Mean pre-treatment glucose levels were higher during the pandemic than before (fasting plasma glucose: +6.3 mg/dl (95% confidence interval: 4.6-8.0)). In the first six months after diabetes diagnosis, the mean number of GP visits, specialist referrals and HbA1c measurements decreased. CONCLUSION: We observed a decrease in diabetes incidence in the early phase of the pandemic and slightly higher pretreatment blood glucose levels during the pandemic than before. Care for newly diagnosed diabetes was slightly worse during the pandemic than before.

[Diabetes and cardiovascular health literacy in childhood and adolescence - a 12-year follow-up]. / Diabetes- und kardiovaskuläre Gesundheitskompetenz im Kindes- und Jugendalter ­ ein 12-Jahres-Follow-up.

BACKGROUND: The incidence of diabetes mellitus and cardiovascular diseases is increasing worldwide and also in Germany. The aim of the study was to assess the health literacy regarding these diseases in childhood and adolescence. METHODS: Students of the 5th-12th grade (grammar school ("Gymnasium"), secondary school forms ("Realschule" and "Hauptschule")) were interviewed in 2007 (n = 4383) and 2019 (n = 572) about diabetes and secondary complications. In addition, questions about other cardiovascular risk factors were asked in 2019. RESULTS: Diabetes-related questions were answered correctly by 56 % in 2007 as well as 53 % in 2019. Among others, 70 % (2007) as well as 75 % (2019) of the students stated "ate too much sugar" as a cause for type 1 diabetes. Further, questions about major risk factors for heart attack and stroke were answered correctly by only 33 % (for diabetes) and 43 %-53 % (for smoking) of students.Across all questions, a positive association indicated between the rate of correct answers and the educational level of the school institution; however, the differences remained marginal at 5-19 % between Gymnasium and Hauptschule or Realschule at both survey time points. A difference between genders was indicated in 2007 (girls: 59 % vs. boys: 52 %) and 2019 (girls: 56 % vs. boys: 51 %). CONCLUSION: Changes in health literacy regarding diabetes and other cardiovascular risk factors among 5th-12th grade students over the past 12 years could not be observed. The assumed self-infliction of type 1 diabetes may be perceived as discrimination by those affected.