DER TYP-II-DIABETES IN DER PRAXIS DER NIEDERGLASSENEN ARZTES: KONZEPT EINER ZENTRUMSUNTERSTUTZTEN BETREUUNG UND ERGEBNISSE EINER STICHPROBEN-ERHEBUNG IM GROSSRAUM MUNCHEN

The concept of cooperation between general practitioners and a diabetes center aims at quality control and improved care of Type II outpatient diabetics. On the basis of seminar teamwork involving 40 general practitioners the diabetes center supplied easy-to-use material for patient training, trained the doctors and medical assistants in the education of diabetics and presented a general framework for structured group education of diabetics. Basic inquiry conducted within the framework of this project describes a topical and otherwise in the Federal Republic of Germany unattainable random sample study of 290 Type II diabetics in the Greater Munich area. 74% of the patients had been diagnosed as diabetics 'by chance', at a mean age of 58 years; a near 40% had a first degree relative who was also a Type II diabetic (in the younger women this percentage was even higher, namely, 53.5%); average duration of diabetes was 7 years and the mean age 65 years. Contrary to our expectations of 50%, only a fair one-third of all the patients were being treated by diet only, whereas 9% injected insulin (the percentage among woman being three times higher). Only 33% of the patients stated that they were following a diet. Particularly large lapses of knowledge were seen in the standardised knowledge test in respect of diet and food care. Only a mere 15% performed regular, i.e. at least once weekly, controls of their urine and blood sugar levels in their home. An excessive risk profile - in most cases a multiple-risk profile - was seen, with paricular emphasis on hypertension (68%) and hypertriglyceridaemia (65%). Only 18% of the patients had a HbA(1c) value within the standard range. Prevalence of coronary heart disease that could be diagnosed by anamnesis plus EGG was 53%, whereas the incidence rate of occlusive artery disease of the legs (diagnosed via Doppler sonography) was 40% and that of extracranial changes in the internal carotid artery, determined by Doppler sonography, 7%. In these cases, too, the complications were specifically frequent in women. It must be assumed that the ambitious aims formulated recently by the WHO in the St. Vincent declaration in respect of reducing complications in diabetes, can be translated into reality only (if at all) by means of institutionalised cooperation between general medical practitioners and a diabetes center.