Zusammenfassung Die Deutsche Diabetes Gesellschaft (DDG) bewertet im vorliegenden Positionspapier Chancen und Risiken eines bevölkerungsbasierten Screenings auf Typ‑1‑Diabetes mittels Insel‑Autoantikörpern in verschiedenen Kontexten. Der Nachweis multipler Antikörper erlaubt die frühe Identifikation präsymptomatischer Stadien mit hohem Progressionsrisiko, bei weiterhin begrenzter individueller Vorhersagbarkeit von Manifestationszeitpunkt und ‑verlauf. Ein potenzieller Nutzen besteht in der Reduktion diabetischer Ketoazidosen und einer möglichen Progressionsverzögerung durch immunmodulatorische Therapien, ist jedoch abhängig von strukturierter Nachsorge und hoher Versorgungsqualität. Dem stehen Einschränkungen durch unzureichend standardisierte Testverfahren, variable Verläufe, fehlende Langzeitdaten sowie psychologische und ethische Aspekte gegenüber. Zudem zeigen gesundheitsökonomische Analysen eine hohe Ressourcenbindung bei unklarer Kosteneffektivität. Insgesamt sieht die DDG derzeit keine Grundlage für ein populationsweites Screening; erforderlich sind bessere Evidenz, validierte Testverfahren und gesicherte Versorgungsstrukturen.

BACKGROUND:We conducted a health economic evaluation alongside the PROVIDE-C randomised controlled trial which analysed the effectiveness of a model of integrated mental health video consultations for people with depression and anxiety in primary care in Germany in comparison to treatment as usual (TAU). METHODS:A cost-effectiveness (CEA) and cost-utility analysis (CUA) were performed six and twelve months after baseline from a societal perspective. Bootstrap procedure was applied and for each bootstrap replication, multiple imputation was conducted, and incremental costs and effects were estimated using generalised linear models. RESULTS:In total 376 participants (18 to 81 years) with depression and/or anxiety were included in the analysis. We found that €3662 would be required for an additional person who experienced a clinically minimum important reduction of 5 points at the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) and €1622 would be required for an additional person with a PHQ-ADS score below 10 points (persons with not more than mild symptom severity) six months after baseline. At twelve months after baseline, PROVIDE-C was dominant compared to TAU. While 6 months after baseline the probability of cost-effectiveness was approximately 36%, 40% and 56% in terms of quality adjusted life years (QALYs) for the respective willingness-to-pay threshold of €0, €20,000, and €100,000, at 12 months after baseline the respective probabilities of cost-effectiveness increased to approximately 71%, 78%, and 86%. CONCLUSIONS:While the PROVIDE-C intervention is less likely cost-effective 6 months after baseline, it was likely cost-effective 12 months after baseline.

Non-adherence to statins represents a contributing factor for poor attainment of low-density lipoprotein cholesterol treatment goals in secondary prevention of coronary artery disease (CAD). We aimed to establish urine analysis by liquid chromatography/mass spectrometry (LC-MS) as a method for objective measurement of non-adherence to high-potency statins. Additionally, we sought to apply the method to a population of ambulatory CAD patients at a German heart center in a cross-sectional pilot study. Volunteers provided urine samples one, two, three, and seven days after intake of a single dose of atorvastatin and/or rosuvastatin. Additionally, urine samples from ambulatory CAD patients on prescription of atorvastatin or rosuvastatin were obtained. All urine samples were analyzed by LC-MS for concentrations of atorvastatin or rosuvastatin. Lower limits of detection were determined on spiked urine samples to define cut-off values (COVs) for the detection of statins (atorvastatin 1.40 ng/mL, rosuvastatin 1.00 ng/mL). Non-adherence was defined as a measurement of the respective statin below the COV. On day one, in volunteers’ (n = 16, 37.3 ± 6 years, 81.3

Several studies have shown that people with diabetes are at higher risk of experiencing a severe course of COVID-19 infection. However, it remains unclear whether diabetes per se is a risk factor for the development of Long/Post-COVID. In addition, there is a lack of nationwide, population-based studies on the epidemiology of Long/Post-COVID in people with diabetes. The aim of this project is to analyze: (1) incidence and time trends of Long/Post-COVID in people with and without diabetes between 2021 and 2023 in Germany as well as potential risk factors; (2) mortality, any hospitalization and hospitalization due to acute myocardial infarction, stroke, amputation and diabetic foot syndrome (DFS) after a Long/Post-COVID diagnosis, including an analysis of potential risk factors. This study is planned as a non-interventional longitudinal observational study based on statutory health insurance (SHI) data in Germany. The data holder is the Health Data Lab (HDL: data pool of billing data for all persons with statutory health insurance). The incidence rates of Long/Post-COVID will be estimated separately in the populations with and without diabetes and compared as corresponding relative risk. Moreover, we will analyse age- and sex-standardized mortality and hospitalization rates within 12, 24, and 36 months after a Long/Post-COVID diagnosis in the years 2021 to 2024. Potential uncertainties in diagnosing Long/Post-COVID (e.g., underreporting) will be addressed in sensitivity analyses. The expected results will have high potential for use in epidemiological research on Long/Post-COVID, including the identification of potential risk factors in people with diabetes. The findings will serve to provide optimized healthcare for Long/Post-COVID patients with diabetes. Trial registration The study has been registered in the German Clinical Trials Register with identifier DRKS00036279. Registration Date 15.05.2025.

INTRODUCTION:Shunting of glycolytic intermediates into the pentose phosphate pathway via transketolase activation by benfotiamine has been suggested to protect from hyperglycemia-induced microvascular damage, but the long-term effects of benfotiamine on diabetic sensorimotor polyneuropathy (DSPN) remain unclear. RESEARCH DESIGN AND METHODS:This 1:1 randomized double-blind, placebo-controlled parallel group monocentric phase II trial compared the efficacy and safety of 1-year treatment with benfotiamine 300 mg two times per day versus placebo over 12 months in participants with type 2 diabetes and mild-to-moderate symptomatic DSPN. The primary endpoint was the change in corneal nerve fiber length (CNFL) assessed by corneal confocal microscopy (CCM) from baseline to 12 months. Secondary endpoints included three other CCM parameters, skin biopsy (four parameters), nerve conduction studies (13 measures), quantitative sensory testing (six parameters), cardiovascular autonomic function tests (17 indices), sudomotor function tests (five parameters), 15 clinical scores and scales for neuropathic symptoms and signs and 13 health-related quality of life and depression instruments. Pharmacokinetics included measurement of six thiamine analytes in blood. RESULTS:A total of 57 participants underwent randomization. The changes from baseline to 12 months in CNFL did not differ between the two groups. The corresponding changes in the secondary morphometric, functional and clinical neuropathic outcomes as well as quality of life were also similar in the two groups. Only the Neuropathy Symptom Score tended to improve after benfotiamine treatment (p=0.098 vs placebo). Benfotiamine treatment increased the concentrations of all six thiamine analytes studied (p≤0.003 vs placebo). Safety analysis showed no relevant differences between the groups in the rates of adverse events. CONCLUSIONS:In type 2 diabetes individuals with mild-to-moderate symptomatic DSPN, treatment with benfotiamine for 12 months was well tolerated, but had no significant effects on multiple morphometric, neurophysiological and clinical measures of neuropathy. TRIAL REGISTRATION NUMBER:European Clinical Trials Database (EudraCT) 2017-003054-16 registered on April 10 (https://eudract.ema.europa.eu/), 2018 and German Register for Clinical Trials DRKS00014832 registered on August 3, 2018 (https://drks.de/search/de).

This systematic review investigates how percutaneous screw osteosynthesis for the treatment of intra-articular displaced calcaneus fractures differs from open reduction and internal fixation (ORIF). Randomized controlled trials and controlled clinical trials investigating adults with closed intra-articular displaced calcaneus fracture (Sanders type II - IV) treated with percutaneous screw osteosynthesis or ORIF were included. Severe vascular and neurological diseases or polytrauma patients were excluded. On January 29, 2024, five databases and two trial registries were searched. The Risk of Bias Tool of Cochrane was used. The protocol was registered on PROSPERO (CRD42021244695). Five studies with 654 participants (682 calcaneus fractures) were included. The risk of bias was moderate to high. None of the single studies found a significant difference regarding severe complications. However, meta-analysis revealed a lower risk for the percutaneous screw osteosynthesis group compared to ORIF (relative risk (RR) 0.40 (95

Background: Individuals with severe mental illness (SMI) have an increased risk for physical comorbidities, such as diabetes and cardiovascular disease, leading to reduced life expectancy. The overshadowing phenomenon is a major contributor to this health inequality, as clinical attention is predominantly focused on the management of psychiatric conditions, often to the detriment of physical health problems. PSY-KOMO aims at filling this gap by implementing an intervention focused on improving the prevention, detection and management of physical diseases in SMI patients through structuring the diagnostic approach of psychiatrists, providing patient navigators and building interdisciplinary health networks. Methods: The study design is a multicentre, non-randomized study with an intervention group (IG) receiving the new treatment PSY-KOMO care compared with a matched external control group (CG) (quasi-experimental design). Three endpoints are evaluated: (1) Improvement in the detection of physical diseases (incidence); (2) improvement in guideline-based treatment of the physical diseases; and (3) improvement of prevention and screening for physical diseases. These endpoints are compared between the IG and the external CG using regression analyses. Based on the sample size calculation, 1,302 participants with severe mental illness (SMI) were planned to be recruited for the intervention group (IG) to analyse the primary endpoint. Patients were included from four distinct regions in Germany: Frankfurt am Main, Neuss, Greifswald, and Göppingen. For analyses and matching of an external control group, data from the Association of Statutory Health Insurance Physicians are used. Discussion: The results will be used to evaluate the effectiveness of the PSY-KOMO intervention. Trial registration: DRKS (DRKS - Deutsches Register Klinischer Studien)- Deutsches Register Klinischer Studien, DRKS00030200 registered on 27 th January 2023.

BackgroundHypertension is a major risk factor for fatal and nonfatal cerebrovascular and cardiovascular events. Poor treatment adherence, a key measure impeding successful treatment, can be improved by incorporating patient preferences. We aimed to identify patient preferences for hypertension treatment outcomes by performing a quantitative exploratory field study using the analytic hierarchy process (AHP). We also explored the associations between patient preferences with prior cardiovascular and cerebrovascular events, sociodemographic factors, and health-related quality of life (HRQoL).MethodsWe quantified preferred outcomes by pairwise comparisons among individuals with hypertension, recruited in secondary and tertiary care settings. Individual weights were calculated using the eigenvector method. HRQoL was assessed via the EQ-5D-5L instrument, including its visual analogue scale.ResultsData from 263 participants revealed that stroke (weight: 0.271) and death (0.270) were equally prioritized as the most worrisome hypertension treatment outcomes, followed by myocardial infarction (0.191), acute heart failure (0.176), and common adverse drug reactions (ADRs) (0.091). Among ADR, dyspnea was consistently ranked as the most concerning. Stratified analyses revealed variations in outcome prioritization: patients with prior stroke or acute heart failure strongly prioritized stroke avoidance, whereas those with myocardial infarction or multiple events emphasized avoiding death.ConclusionsThis is the first study to apply AHP to hypertension treatment preferences, identifying stroke and death as equally worrisome outcomes, clearly prioritized for avoidance. Thus, prolonging life is not universally the primary goal among patients. Integrating patient preferences into clinical decision-making may support a more patient-centered approach and improve treatment adherence and outcomes.

Abstract Background Lifestyle interventions can increase the probability of remission of prediabetes to normal glucose tolerance, but their economic value remains unclear. We assessed the within-trial and lifetime-horizon modeled cost-effectiveness of intensive and conventional lifestyle interventions in risk-stratified participants with prediabetes. Methods A health economic evaluation was conducted alongside the 12-month multicenter PLIS trial (n=1,105). High-risk participants were randomized to intensive (HR-INT) or conventional (HR-CONV); low-risk participants to conventional lifestyle intervention (LR-CONV) or control (only short single consultation; LR-CTRL) with risk stratification based on insulin secretion, insulin sensitivity, and liver fat content. Within-trial analyses estimated incremental costs per additional remission to normoglycemia and per quality-adjusted life year (QALY). Lifetime cost-effectiveness was modelled using a four-state Markov Model. Findings At 12 months, HR-INT and LR-CONV increased remission compared with their respective comparators. The incremental cost per additional remission was €7,081 (95% CI: dominated-47,277) for HR-INT and €4,278 (1,312–11,793) for LR-CONV from a health insurance perspective. A willingness-to-pay of €22,000 (HR-INT) and €7,500 (LR-CONV) per additional remission corresponded to 90% probability of cost-effectiveness. Neither intervention was cost-effective in terms of QALYs gained within the 12-months period. Lifetime modelling suggested that both HR-INT and LR-CONV are not only cost-effective, but also cost-saving, relative to HR-CONV and LR-CTRL, respectively. Also in the probabilistic sensitivity analysis, most simulations indicated dominance (71.7% for HR and 88% for LR). Interpretation Based on short-term economic evaluation, the interventions assessed were cost-effective regarding additional participants with remission, not for incremental QALYs gained. Lifetime modelling suggests cost savings for both risk groups. Targeting populations with lifestyle interventions to achieve prediabetes remission seems to generate good value for money in the long term. Trial registration number: NCT01947595 Research in context What is already known about this subject? Lifestyle modification is pivotal for type 2 diabetes prevention in individuals with prediabetes; improvements are needed to overcome nonresponse to preventive interventions. The 12-month Prediabetes Lifestyle Intervention Study (PLIS) was the first multicenter study, which involved eight study sites in university hospitals in Germany, where investigators prospectively tested different intensities of lifestyle intervention in a risk-stratified manner. PLIS achieved higher remission rates of prediabetes with an intensive lifestyle intervention (16 counseling sessions) in high-risk participants and a conventional lifestyle intervention (8 counselling sessions) in low-risk participants, relative to a conventional (8 counselling sessions) and control lifestyle intervention (single short counselling session), respectively. As risk-stratified diabetes prevention has not been implemented so far and more intense lifestyle interventions are usually associated with higher healthcare utilization, it remains unclear whether these interventions are cost-effective. What is the key question? Are intensive and conventional lifestyle interventions of the Prediabetes Lifestyle Intervention Study cost-effective after 12 months and over the lifetime horizon? What are the new findings? Intensive lifestyle intervention in high-risk participants and the conventional lifestyle intervention in low-risk participants are both likely to be cost-effective at a willingness-to-pay threshold between €10,000 and €20,000 per additional person with prediabetes remission. Neither intensive lifestyle intervention nor conventional lifestyle intervention are cost-effective in terms of quality adjusted life years gained in the 12-month trial period; however, this was not unexpected, given the limited scope for short-term improvement in health-related quality of life in a largely asymptomatic population with high baseline utility values. Simulation modeling with a lifetime horizon thereby shows that intensive lifestyle intervention in high-risk participants and conventional lifestyle intervention in low-risk participants may be not only cost-effective but also cost-saving. How might this impact on clinical practice in the foreseeable future? Individualized, risk phenotype-based lifestyle intervention in prediabetes may be cost-effective regarding remission to normal glucose regulation in the short- and regarding quality-adjusted life years gained the long-term. When evaluating lifestyle-based type 2 diabetes prevention, a long-term perspective is essential, as the intervention may translate into clinically meaningful and economically relevant benefits only over time through delayed diabetes onset, fewer diabetes-related complications, and reduced healthcare utilization.

Physical inactivity is a persistent public health challenge with 52

To identify ICD-10-GM codes recorded in the year preceding a Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) diagnosis, we conducted a 1:5 matched case–control study using statutory health insurance data of 6–27-year-olds with ME/CFS (ICD-10-GM: G93.3, 2020–2022). Cases (n = 6,077) were matched 1:5 to controls by birth year, sex, and postal code. ICD-10-GM codes from the preceding year were analyzed using multivariable conditional logistic regression, reporting odds ratios (OR) and 95% confidence intervals. Most cases were female and aged 18–27 years. Forty-four ICD-10-GM code classes were associated with increased and four with decreased odds, spanning 13 diagnostic chapters. Most associations were in chapters F (mental/behavioral disorders), R (respiratory diseases), and M (musculoskeletal disorders). Frequent conditions included fatigue, depression, pain disorders, and somatoform disorders (≥ 10% in cases; ORs 1.11–2.19. Rare diagnoses (≤ 1% prevalence), such as fibromyalgia (OR 2.08, 95% CI: 1.20–3.59) and mild cognitive impairment (2.93, 1.21–7.10), were strongly associated. Four COVID-19 or vaccination-related code classes were identified, with post-COVID-19 condition showing the highest OR (3.84, 2.97–4.98). Several ICD-10-GM codes, including COVID-19 related codes, were associated with later ME/CFS diagnoses. Prospective studies should clarify timing relative to ME/CFS onset, and distinguish between pre-existing conditions, comorbidities, early manifestations, or misdiagnoses.

Background/Objectives: Pediatric-onset multiple sclerosis (POMS), defined as onset before age 18, is increasingly recognized as a distinct entity, often associated with a more burdensome disease course and earlier disability milestones than adult-onset MS. Although comorbidities may significantly affect disease progression and outcomes, their prevalence, incidence, risk, and characteristics in POMS remain poorly understood. To date, no systematic review has comprehensively evaluated comorbidities in POMS. The primary aim is to systematically identify and synthesize available evidence on the prevalence, incidence, risk, and characteristics of these comorbidities in POMS populations, as well as any reported effects on disease course, treatment outcomes, and overall clinical management. Methods: We will conduct a systematic review and meta-analysis following a hierarchical and pragmatic analytical strategy tailored to the expected heterogeneity and limited evidence base in POMS. MEDLINE (via PubMed) and Embase (produced by Elsevier) will be searched without date restrictions, combining controlled vocabulary terms (MeSH/Emtree) and relevant keywords for POMS and 15 predefined comorbidity categories. Study selection, abstract and full-text screening, and data extraction will be performed independently by two reviewers using predefined criteria and standardized forms. The primary quantitative outcome will be the pooled prevalence of comorbidities. Where study design and reporting permit, incidence rates will be assessed as secondary outcomes, and risk estimates (e.g., odds ratios) will be evaluated only in studies with appropriate comparator groups. Meta-analyses will be conducted using random-effects models when pooling is feasible. Heterogeneity will be assessed using the I2 statistic and Cochran’s Q test, with sensitivity and subgroup analyses performed only when sufficient data are available. When quantitative synthesis is not appropriate due to limited data or substantial heterogeneity, findings will be summarized descriptively. Publication bias will be evaluated using funnel plots and, where applicable, Egger’s and Begg’s tests. This protocol adheres to PRISMA and PRISMA-P guidelines. Discussion: A systematic quantification of comorbidity prevalence, incidence (where available), and risk, together with POMS-specific characteristics and any reported impact on clinical outcomes, is anticipated to provide a crucial evidence base for guiding screening, refining management strategies, and informing future research directions. Ultimately, these findings may improve clinical outcomes and quality of life for children and adolescents with MS.

INTRODUCTION:The Standardised Endpoints in Perioperative Medicine Initiative recommends the 12-item WHO Disability Assessment Schedule (WHODAS) 2.0 to measure postoperative functional impairment. However, evidence describing long-term postoperative disability, particularly at 1 year, remains limited. This study aimed to: describe disability up to 1 year after non-cardiac, non-neurosurgical procedures; examine associations between periprocedural risk, postoperative complications and new-onset disability; and evaluate associations between social support, delirium, and frailty and postoperative disability. METHODS:We conducted a prospective, multicentre cohort study. The primary endpoint was new onset clinically significant disability (an increase in WHODAS 2.0 score ≥ 5% points from baseline to a final score ≥ 35%) or death at 1 year. Independent variables included: periprocedural risk; postoperative complications; frailty; and patient-reported social support. RESULTS:In total, 1081 patients were included: 726 (67%) male, median (IQR) [range] age 67 (60-75 [50-101]) y. New onset clinically significant disability was present in 139/1081 (12.9%) patients at 1 year and in 238/1066 (22.3%) patients at 30 days. Periprocedural risk (adjusted odds ratio (aOR) 1.05, 95%CI 1.03-1.07, per percent in American College of Surgeons National Surgical Quality Improvement Program score) and postoperative complications of all grades were associated with 1-year new onset clinically significant disability. New onset (1 year) clinically significant disability was not associated with social support: OR 0.87, 95%CI 0.54-1.39 for moderate; and OR 0.76, 95%CI 0.47-1.24 for strong social support. Frailty was strongly associated with new onset clinically significant disability after 1 year (aOR 3.97, 95%CI 2.54-6.21). DISCUSSION:One year after non-cardiac surgery, 13% of surviving patients experienced a new onset clinically significant disability. Postoperative complications, even those of low severity, were associated with new onset postoperative disability.

Type 2 diabetes (T2D) prevention efforts have largely focused on intervening when dysglycemia is already established. We propose that T2D prevention be reframed around prediabetes remission, with preservation and restoration of normoglycemia as the optimal clinical goal. The transition from normoglycemia through increasing dysglycemia to T2D is progressive and cumulatively shaped by biological, behavioral and environmental exposures across the life course. Prediabetes (intermediate hyperglycemia) remission is an achievable, pragmatic and measurable prevention target. Here we provide a life-course risk architecture for T2D integrating developmental, transitional and contextual determinants, defining critical windows of amplified metabolic vulnerability and potential restoration of normoglycemia. Precision prevention should target mechanistic heterogeneity, with aligned interventions that remain scalable, affordable and adaptable across socioeconomic settings. Our framework identifies ten priorities in T2D prevention, moving beyond traditional approaches toward context-specific, actionable interventions capable of altering the natural history of disease early in the life course and restoring metabolic health.

BackgroundAlthough diabetes mellitus is an established risk factor for acute myocardial infarction (AMI), epidemiological studies showed wide variations in the incidence of AMI in people with diabetes and inconsistent time trends. The objectives of the present systematic review were as follows: (i) to analyze the age-sex-adjusted incidence of both non-fatal and fatal AMI in people with diabetes compared to those without diabetes, (ii) to investigate corresponding time trends, and (iii) to identify sex differences.MethodsA systematic literature search was performed in the literature databases MEDLINE, Embase, and LILACS until July 19, 2023, to identify population-based studies reporting the incidence of AMI in people with diabetes compared to those without diabetes according to our predefined inclusion criteria.ResultsIn total, 28 population-based cohort studies were included in this review. In women with diabetes, the incidence of AMI ranged from 102 to 690 per 100,000 person-years, and in men with diabetes from 206 to 1630. Estimates comparing people with and without diabetes ranged from 1.55 (95% CI 1.44-1.67) to 14.37 (8.43-24.47) in women and from 1.33 (1.18-1.51) to 4.17 (2.72-6.37) in men. Over the past four decades, the incidence of AMI declined in almost all studies in people without diabetes, but only in half of the studies in people with diabetes. There was considerable heterogeneity with regard to the definition of AMI, the population with diabetes, and geographic differences.ConclusionIncidence of AMI in people with diabetes remained significantly higher than in those without diabetes. A reduction in the incidence of AMI over time was observed in some, but not all reviewed studies in people with diabetes. There was no discernible trend of estimates comparing people with and without diabetes. These findings underscore the necessity for additional initiatives to prevent coronary heart disease in people with diabetes. The observed discrepancy in study results is presumably attributable to variations in the population and regional contexts, as well as to disparate methodological approaches. More standardized studies employing comparable methodologies are therefore required.Systematic review registrationPROSPERO CRD42 02014 5562

Introduction: Parental cancer affects the whole family and can have negative impact on family as a system as well as on single family members. This multicentre, prospective, interventional and non‐randomized family‐SCOUT study aimed to implement a comprehensive psychosocial intervention to provide support for the family during and after the disease. The purpose of this study is to analyse the contextual factors that impact the subjective perceived effectiveness of family‐scout support for families affected by parental cancer from the healthy parents’ perspective. Methods: Semi‐structured interviews with the healthy parent as a surrogate of family‐SCOUT families from the intervention group were conducted. All interviews were audio‐recorded, transcribed and analysed using template analysis. Results: Within two years, 23 interviews were conducted. Four themes were identified, highlighting contextual factors that indicate successful support for families: Ability to meet the support needs of families; cancer as a family disease—burdens in the context of the family system; coping strategies—how the individual family members deal with the situation and communication within the family. Conclusion: Family‐scouts can provide beneficial support to families affected by parental cancer, but individual time of the families, communication and stress factors need to be taken into consideration. Trial Registration: ​ Familien‐SCOUT: NCT04186923

Persons with diabetes mellitus have complex healthcare needs. Existing disease management programmes (DMPs) are based on a one-size-fits-all approach. However, individuals might require more individualised care. This study aims to identify groups with different patterns of healthcare utilization among people with diabetes in Germany and factors associated with these different patterns. A cross-sectional survey was conducted among a random sample from a statutory health insurance (SHI) with diabetes (n = 1332) and linked to longitudinal SHI data. Latent class analysis was used to identify subgroups with similar patterns of healthcare utilization and factors associated with different patterns. Four patterns of healthcare utilization were identified among people with diabetes: ‘low users’ (20.8% of the total sample); ‘low users with ophthalmologist visit’ (45.2%); ‘high users’ (26.5%); and ‘high users with mental health care’ (7.5%). The classes differed significantly in age, sex, type, duration and severity of diabetes, DMP membership, diabetes training, health-related quality of life, and prevalence of depression. The ‘high users with mental health care’ class was for example younger, more female, had a lower quality of life and the highest prevalence of depression. This study may provide a first basis for thinking about targeted care in Germany beyond DMPs.