[Disease management program (DMP) diabetes mellitus: simulation of therapeutic results of different guidelines. A new diabetes mellitus model (DMM)]

Dtsch Med Wochenschr. 2003 May 23;128(21):1167-72. doi: 10.1055/s-2003-39354.
[Article in German]

Abstract

Background and objective: In conjunction with the introduction of disease management programmes in Germany there is an ongoing scientific debate on the desirable goals for HbA1c in the management of patients with type 2 diabetes mellitus.

Patients and methods: In this study, a novel computer-based simulation model (diabetes mellitus model = DMM) was used to estimate the consequences of different levels of metabolic control as assessed by HbA1c for the development of short- and long-term complications of this disease.

Results: At a mean difference of 1 % the rate of severe hypoglycaemic events over 10 years was by 32-84 % higher in those with a lower HbA1c. In contrast, the incidence of microvascular complications (proliferative retinopathy, end-stage kidney disease, clinical neuropathy) was by 20-33 % lower in the group with the lower as compared to the higher HbA1c level according to the scenario applied. The rates of myocardial infarction and stroke were reduced by 15-20 % under these conditions.

Conclusions: This model calculation suggests that a more strict metabolic control in patients with type 2 diabetes mellitus results in a greater reduction of microvascular complications than of macrovascular complications, but is associated with a higher rate of hypoglycaemic episodes. The diabetes mellitus model is a non-expensive alternative to simulate clinically relevant questions on the management of type 2 diabetes and to provide rapid and realistic answers.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control
  • Computer Simulation*
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / therapy*
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / therapy*
  • Diabetic Angiopathies / epidemiology
  • Diabetic Angiopathies / prevention & control
  • Diabetic Nephropathies / epidemiology
  • Diabetic Nephropathies / prevention & control
  • Diabetic Neuropathies / epidemiology
  • Diabetic Neuropathies / prevention & control
  • Diabetic Retinopathy / epidemiology
  • Diabetic Retinopathy / prevention & control
  • Disease Management*
  • Glycated Hemoglobin A / analysis
  • Humans
  • Hypoglycemia / epidemiology
  • Hypoglycemia / prevention & control*
  • Middle Aged
  • Risk Factors

Substances

  • Glycated Hemoglobin A