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München, Germany

Kolb H.,Hagedorn Research Institute | Kempf K.,Sana Clinics Dusseldorf GmbH | Martin S.,Sana Clinics Dusseldorf GmbH | Stumvoll M.,University of Leipzig | Landgraf R.,German Diabetes Foundation
Diabetes Research and Clinical Practice

Self-monitoring of blood glucose (SMBG) has been considered one major breakthrough in diabetes therapy because, for the first time, patients were able to determine their blood glucose levels during daily life. It seems obvious that this must be of advantage to disease management and clinical outcome, but it has become a nightmare for those trying to provide evidence. Randomised controlled trials have yielded inconsistent results on a benefit of SMBG-based treatment strategies not only in type 2 but - surprisingly - also in type 1 and gestational diabetes. Despite this, SMBG is being considered indispensible in intensive insulin treatment, but is being debated for other clinical settings. When considering the non-RCT based reasons for recommending SMBG in type 1 and gestational diabetes it becomes apparent that the same reasons also apply to type 2 diabetes. © 2009 Elsevier Ireland Ltd. All rights reserved. Source

Ruch C.,Tumaini Institute for Prevention Management | Eh Schwarz P.,TU Dresden | Kohler D.,German Diabetes Foundation | Hoffmann R.,German Diabetes Foundation | Landgraf R.,German Diabetes Foundation
British Journal of Diabetes and Vascular Disease

The rising prevalence of type 2 diabetes is having an impact on limited medical and economic resources making increased efficiency and effectiveness of medical care and preventative strategies imperative. Quality management indicators that are fit for purpose will permit improvements and shortcomings to be identified in the strategies being employed and may provide information on how to better achieve objectives. This article considers two approaches to how indicators, which were developed by the Implementation of A European Guideline and training standards for diabetes prevention project, can be used in clinically applicable quality management, including benchmarking, in order to compare the quality of work among prevention managers and to develop an overall benchmark for preventive intervention. © 2011 SAGE Publications. Source

Martin E.,Red Cross | Ruf E.,Red Cross | Landgraf R.,German Diabetes Foundation | Hauner H.,TU Munich | And 2 more authors.
Hormone and Metabolic Research

Despite the efforts to control the epidemic of diabetes the total number of people living with diabetes is still steadily rising. In order to detect people at risk, cost-effective, convenient, and sensitive screening tools to assess the diabetes risk and to detect undiagnosed type 2 diabetes need to be developed and implemented in the primary care setting. To evaluate the combination of the well established FINDRISK questionnaire and HbA1c testing as a potential screening strategy the data obtained from 671 blood donors were analyzed for a potential correlation with the results of an oral glucose tolerance test. Based on the oral glucose tolerance test, 65 blood donors (9.7%) were newly diagnosed with diabetes, 336 (50.1%) with prediabetes, and 270 (40.2%) had a normal test result. Of the 401 blood donors diagnosed with prediabetes or diabetes 322 (80.3%) had a HbA1c between 5.7% and 6.4% and 27 (6.7%) with a HbA1c of 6.5% or greater. The majority of the blood donors newly diagnosed with diabetes or prediabetes (n=327) had a FINDRISK result of 12 points or higher. ROC analyses confirmed that the optimal cut off levels were for FINDRISK 12 points and for HbA1c 5.9%. Thus, a 3-step screening strategy applying the FINDRISK questionnaire followed by HbA1c testing and performing an oral glucose tolerance test on selected individuals could be a cost-saving approach for screening large populations and identifying people at risk for diabetes or undiagnosed diabetes. © Georg Thieme Verlag KG Stuttgart · New York. Source

Pajunen P.,Finnish National Institute for Health and Welfare | Landgraf R.,German Diabetes Foundation | Muylle F.,Vlaamse Diabetes Vereniging Vzw | Neumann A.,TU Dresden | And 4 more authors.
Hormone and Metabolic Research

Background: The marked increase of type 2 diabetes necessitates active development and implementation of efficient prevention programs. A European level action has been taken by launching the IMAGE project to unify and improve the various prevention management concepts, which currently exist within the EU. This report describes the background and the methods used in the development of the IMAGE project quality indicators for diabetes primary prevention programs. It is targeted to the persons responsible for diabetes prevention at different levels of the health care systems. Methods: Development of the quality indicators was conducted by a group of specialists representing different professional groups from several European countries. Indicators and measurement recommendations were produced by the expert group in consensus meetings and further developed by combining evidence and expert opinion. Results: The quality indicators were developed for different prevention strategies: population level prevention strategy, screening for high risk, and high risk prevention strategy. Totally, 22 quality indicators were generated. They constitute the minimum level of quality assurance recommended for diabetes prevention programs. In addition, 20 scientific evaluation indicators with measurement standards were produced. These micro level indicators describe measurements, which should be used if evaluation, reporting, and scientific analysis are planned. Conclusions: We hope that these quality tools together with the IMAGE guidelines will provide a useful tool for improving the quality of diabetes prevention in Europe and make different prevention approaches comparable. © Georg Thieme Verlag KG Stuttgart - New York. Source

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