Introduction This study investigates the association between type 2 diabetes mellitus and six psychosocial burdens (depressive symptoms, loneliness, and low levels of energy, life satisfaction, satisfaction with one’s activity level, and perceived social support) among older adults, using data from the population-based longitudinal study Gesundheit 65+ in Germany.Research design and methods Data were collected from June 2021 to April 2023 via a baseline survey and three follow-up waves, primarily using paper questionnaires. The present study included 12,514 observations across 3,547 participants aged 65 and older. The presence of type 2 diabetes in the last 12 months was self-reported. Psychosocial burdens were assessed using validated scales. Binomial and multinomial logistic regressions were conducted, adjusting for sex, age, education, physical activity, obesity, cardiovascular comorbidities and cancer.Results Type 2 diabetes was significantly associated with all examined psychosocial burdens in the unadjusted analysis. In the fully adjusted model, having type 2 diabetes increased the odds of experiencing depressive symptoms (OR 1.60, 95% CI 1.18 to 2.17), low energy (1.37, 95% CI 1.06 to 1.77), low/middle life satisfaction (1.41, 95% CI 1.15 to 1.73), loneliness (1.31, 95% CI 1.03 to 1.66) and neither satisfaction nor dissatisfaction with one’s activity level (1.38, 95% CI 1.11 to 1.72), whereas the association with perceived social support lost statistical significance. Sensitivity analysis confirmed the results. No significant interactions were found for sex, age group, or study wave.Conclusions Type 2 diabetes is associated with higher odds of different psychosocial challenges in older adults. These findings emphasize the need for integrated care models that routinely screen for and manage these conditions in persons with diabetes.

OBJECTIVE:There is increasing evidence that the link between type 2 diabetes (T2D) and mental health may be partly due to shared modifiable risk factors. The present study examined whether a higher predicted T2D risk is associated with poorer self-rated general health (SRH) and mental health (SRMH) as well as depressive and anxiety symptoms among adults without diagnosed diabetes. METHODS:Analyses are based on cross-sectional data from 4,909 adults (18 + years) without known diabetes who participated in the nationwide telephone interview survey German Health Update (GEDA) 2022. The predicted 5-year T2D risk (in %) was assessed with the German Diabetes Risk Score (GDRS) and categorized into very low (<2%), low (2- < 5%), elevated (5- < 10%) and high (≥10%) risk groups. Poisson regression was used to calculate prevalence ratios (PRs) of SRH, SRMH, depressive and anxiety symptoms according to T2D risk categories and models were adjusted for sex, age, education, region, living alone, and social support. RESULTS:Predicted T2D risk (95% confidence interval (CI)) was very low for 60.8% (58.7-63.0%), low for 15.7% (14.2-17.2%), elevated for 10.7% (9.5-12.1%), and high for 12.8% (11.5-14.2%) of adults. Compared to those with very low T2D risk, participants at high T2D risk were less likely to report very good/good SRH (PR; 95% CI: 0.65; 0.56-0.75) or excellent/very good SRMH (0.65; 0.51-0.81) and more likely to have depressive (2.48; 1.70-3.63) or anxiety symptoms (2.50; 1.54-4.05). CONCLUSION:Findings underline that physical and mental health should be considered together in the context of prevention and health promotion strategies.

Background:Coronary heart disease (CHD) is the leading cause of death in Germany. Comprehensive analyses of long-term trends in CHD mortality that also distinguish between acute myocardial infarction (AMI) and non-AMI-related chronic CHD are currently lacking. Method:Age-specific and age-standardised CHD mortality rates for the period 1998 - 2023 were calculated based on data from the cause-of-death statistics of the Federal Statistical Office of Germany. Annual percentage changes (APC) and average annual percentage changes (AAPC) were estimated using joinpoint regression analysis. Results:Between 1998 and 2023, the average annual change in age-standardised CHD mortality rates for women was -3.9 % ((-4.1) - (-3.7)) per year, compared with -3.2 % ((-3.3) - (-3.0)) for men. However, since the 2010s, the downward trend in CHD mortality has flattened, particularly among those aged 60 to 74 years. In the analysis by ICD subgroups, mortality rates for chronic CHD declined less sharply than for AMI over the entire period 1998 - 2023, especially among men. Conclusions:The flattening of the CHD mortality trend, particularly among middle-aged adults over the last decade, and the smaller decline in chronic CHD mortality, especially among men, require further exploration in order to identify unmet needs at various levels of prevention for specific life stages. In addition, the influence of the COVID-19 pandemic on CHD mortality trends should be further investigated.

Background: The Robert Koch Institute (RKI) continuously monitors key health indicators in the general population by collecting data repeatedly. As changes in survey design can affect prevalence estimates and thus make interpreting trends difficult, the launch of the RKI Panel ‘Health in Germany’ was accompanied by a methodological study. Methods: The RKI Panel is based on a random sample drawn from population registers. The survey is self-administered in written format (online or paper). The composition of the sample, prevalence estimates and response behaviour were then compared with data collected in parallel in the GEDA 2024 telephone survey. Data from previous surveys were included in the modelling to quantify method-related differences in prevalence estimates. Results: The RKI Panel 2024 was more successful in representing young adults, the elderly and individuals with low levels of education. The prevalence estimates differ significantly from GEDA 2024 in some cases, particularly for mental health indicators and their associated factors. The RKI Panel includes more older adults with limited physical health, while in young adults more participants with poorer mental health are present. Despite method-related differences in prevalence, modelling can usually be used to assess trends. Conclusions: The RKI Panel provides a more realistic representation of the German population than previous telephone surveys. The differences in prevalence are due to effects of the survey mode, questionnaire design, and changes in sample composition.

Background: Devices for continuous glucose monitoring (CGM) have been developed to optimize blood glucose control and liberate people with diabetes from finger-prick glucose measurements. Since 2016, the devices have been reimbursed in Germany for people with diabetes receiving insulin therapy, resulting in their increased use among people with type 1 diabetes (T1D) and type 2 diabetes (T2D). We investigated the prevalence of CGM use and its associated factors among German adults with diabetes in 2017 and 2021/2022. Methods: Participants aged 18 years or older with diagnosed diabetes were identified from two nationwide population-based telephone surveys in 2017 (n = 1396) and 2021/2022 (n = 1456). Prevalence and dynamics of CGM use were examined overall and stratified by sociodemographic and diabetes-related characteristics. Factors associated with CGM use were obtained from logistic regression models. Results: The overall prevalence of CGM use was 8.2% in 2017 and 16.6% in 2021/2022. An increase in CGM use was observed across all the subgroups except for those without antidiabetic medications. CGM use increased from 31.1% to 75.4% in adults with T1D, from 6.3% to 13.6% in adults with T2D, and from 14.6% to 36.7% in all insulin users. In both surveys, younger age, insulin use, T1D, and reporting hypoglycemia were associated with CGM use. In addition, in 2017, higher education level and absence of obesity were associated with CGM use, whereas in 2021/2022, participation in the diabetes self-management education program and higher self-assessed quality of diabetes care were associated with CGM use. Conclusion: Among adults with diabetes in Germany, CGM use increased about twofold within 5 years, irrespective of sociodemographic factors. Educational inequality in CGM use diminished over time. The higher self-rated quality of diabetes care associated with the recent use of CGM provides further evidence to support its use among all adults with diabetes in Germany.

Background:This study examines differences in life expectancy between Germany's most affluent and most deprived areas. Methods:Nationwide data from the cause-of-death statistics from 2003 to 2022 were linked with official population data to calculate the average life expectancy of females and males in each of Germany's districts. Regression analysis was used to assess the association with the German Index of Socioeconomic Deprivation (GISD) at district level and calculate the life expectancy gap between the most and least deprived areas. Results:In the period 2020 - 2022, life expectancy in the most deprived areas was 4.3 years (females) and 7.2 years (males) lower than in the least deprived areas. In the period 2003 - 2005, this life expectancy gap was still 2.6 and 5.7 years. The widening of the life expectancy gap resulted from a less favourable development of life expectancy in the most deprived areas. It was already evident before and intensified during the COVID-19 pandemic. Conclusions:The increasing life expectancy gap indicates that health inequality in Germany is increasing. As a result, the development of a strategy to improve health equity is more important than ever to be placed on the policy agenda.

Background People with diabetes should be actively involved in their healthcare. Their perspective on the quality of care in the interaction with the medical team is therefore meaningful, e.g., with respect to setting individual therapy goals. Aim As part of a nationwide, population-based survey in Germany, quality of care was assessed from the perspective of people with type 2 diabetes aged 45 years and over and examined in relation to sociodemographic, disease- and care-related characteristics in order to identify potential for improvement. Methods The self-assessed quality of care was determined using the Patient Assessment of Chronic Illness Care-DAWN short form (PACIC-DSF), a survey instrument consisting of nine individual components. A higher mean value of the PACIC-DSF score or of the nine components (scale: 1-5 in each case) indicates a better self-assessed quality of care in the last year. Results The overall quality of care for type 2 diabetes was rated as moderate (2.4). Women, people aged 80 years and over and people with a duration of diabetes < 5 years rated their quality of care as less good in comparison to the reference groups. Participation in diabetes self-management education (DSME), medical diagnostic measures, medication (particularly insulin), and blood glucose self-monitoring (particularly continuous glucose monitoring) were associated with a better self-assessed quality of care. More than half of the respondents stated that they had rarely or never experienced most of the PACIC-DSF components in the last year, e.g. being encouraged to participate in DSME or asked about adverse effects of medication and individual treatment goals. Discussion The results indicate that a stronger implementation of person-centered treatment appears necessary. People with a short duration of diabetes and without medication could be more closely involved, e.g., by asking them about their wishes regarding treatment. DSME and medical diagnostic measures may improve the quality of care.

Background: In order to assess the prevention and care needs for type 2 diabetes in the coming decades from a public health perspective, forecasts on the trends in prevalence and case numbers are essential. Methods: The data are based on age-specific estimates of diagnosed diabetes prevalence from the survey German Health Update (GEDA) 2022, and on the proportion of type 2 diabetes derived from routine health insurance data. Using routine data on the incidence and excess mortality of diabetes, various scenarios for the future trends of type 2 diabetes are modelled using an illness-death model. Results: Based on a type 2 diabetes prevalence of 8.6 % in 2022 (women: 8.2 %, men: 9.2 %), corresponding to a total of 6.05 million cases (women: 2.92 million, men 3.13 million), the prevalence is expected to rise to 16.1 % by 2050 (women: 14.8 %, men: 17.4 %), with the number of cases increasing to 11.01 million (women: 5.19 million, men: 5.82 million). Assuming a 2.0 % annual decline in incidence, the prevalence is expected to rise to only 12.2 % (8.39 million cases); with a simultaneous 2.0 % annual decline in excess mortality, the prevalence is expected to reach 13.0 % (8.94 million cases). Conclusions: The prognosis is mainly influenced by changes in incidence. Primary preventive approaches to reduce risk factors for type 2 diabetes are therefore crucial to counteract an increase in the number of type 2 diabetes cases.

Background. Earlier mortality in socioeconomically disadvantaged population groups represents an extreme manifestation of health inequity. This study examines the extent, time trends, and mitigation potentials of area-level socioeconomic inequalities in premature mortality in Germany. Methods. Nationwide data from official cause-of-death statistics were linked at the district level with official population data and the German Index of Socioeconomic Deprivation (GISD). Age-standardized mortality rates before the age of 75 were calculated stratified by sex and deprivation quintile. A what-if analysis with counterfactual scenarios was applied to calculate how much lower premature mortality would be overall if socioeconomic mortality inequalities were reduced. Results. Men and women in the highest deprivation quintile had a 43% and 33% higher risk of premature death, respectively, than those in the lowest deprivation quintile of the same age. Higher mortality rates with increasing deprivation were found for cardiovascular and cancer mortality, but also for other causes of death. Socioeconomic mortality inequalities had started to increase before the COVID-19 pandemic and further exacerbated in the first years of the pandemic. If all regions had the same mortality rate as those in the lowest deprivation quintile, premature mortality would be 13% lower overall. Discussion. The widening gap in premature mortality between deprived and affluent regions emphasizes that creating equivalent living conditions across Germany is also an important field of action for reducing health inequity.

Background:Migration-related factors, such as language barriers, can be relevant to the risk, healthcare and complications of type 2 diabetes in people with a history of migration. Diabetes-related data from people with selected citizenships were analysed on the basis of the nationwide survey German Health Update: Fokus (GEDA Fokus). Methods:The diabetes risk of persons without diabetes (n = 4,698, 18 - 79 years), key figures on healthcare and secondary diseases of persons with type 2 diabetes (n = 326, 45 - 79 years) and on concomitant diseases (n = 326 with type 2 diabetes compared to n = 2,018 without diabetes, 45 - 79 years) were stratified according to sociodemographic and migration-related characteristics. Results:Better German language proficiency is associated with a lower risk of diabetes. Diabetes-related organ complications are observed more frequently in persons who report experiences of discrimination in the health or care sector. Both persons with and without diabetes are more likely to have depressive symptoms when they reported experiences of discrimination. A stronger sense of belonging to the society in Germany is associated with reporting depressive symptoms less often in people without diabetes, but not in people with type 2 diabetes. Conclusions:The differences according to migration-related characteristics indicate a need for improvement in the prevention and care of type 2 diabetes. Migration-sensitive indicators should be integrated into the surveillance of diabetes.

BACKGROUND:Earlier death among people in socioeconomically deprived circumstances has been found internationally and for various causes of death, resulting in a considerable life-expectancy gap between socioeconomic groups. We examined how age-specific and cause-specific mortality contributions to the socioeconomic gap in life expectancy have changed at the area level in Germany over time.METHODS:In this ecological study, official German population and cause-of-death statistics provided by the Federal Statistical Office of Germany for the period Jan 1, 2003, to Dec 31, 2021, were linked to district-level data of the German Index of Socioeconomic Deprivation. Life-table and decomposition methods were applied to calculate life expectancy by area-level deprivation quintile and decompose the life-expectancy gap between the most and least deprived quintiles into age-specific and cause-specific mortality contributions.FINDINGS:Over the study period, population numbers varied between 80 million and 83 million people per year, with the number of deaths ranging from 818 000 to 1 024 000, covering the entire German population. Between Jan 1, 2003, and Dec 31, 2019, the gap in life expectancy between the most and least deprived quintiles of districts increased by 0·7 years among females (from 1·1 to 1·8 years) and by 0·1 years among males (from 3·0 to 3·1 years). Thereafter, during the COVID-19 pandemic, the gap increased more rapidly to 2·2 years in females and 3·5 years in males in 2021. Between 2003 and 2021, the causes of death that contributed the most to the life-expectancy gap were cardiovascular diseases and cancer, with declining contributions of cardiovascular disease deaths among those aged 70 years and older and increasing contributions of cancer deaths among those aged 40-74 years over this period. COVID-19 mortality among individuals aged 45 years and older was the strongest contributor to the increase in life-expectancy gap after 2019.INTERPRETATION:To reduce the socioeconomic gap in life expectancy, effective efforts are needed to prevent early deaths from cardiovascular disease and cancer in socioeconomically deprived populations, with cancer prevention and control becoming an increasingly important field of action in this respect.FUNDING:German Cancer Aid and European Research Council.

Background: In Europe, the health situation is primarily influenced by non-communicable diseases. Comparable information on key indicators for the European region can highlight potential areas for improvement in prevention and care. Method: Based on EHIS 3, age-standardised prevalences of three disease groups and two indicators of self-assessed health among those affected were presented for Germany (n = 22,708) and the average of 29 European countries (n = 301,960). Results: The disease prevalence estimates in Germany were higher compared to the European average: diabetes 8.4 % vs. 7.4 %, cardiovascular diseases 6.8 % vs. 5.7 %, chronic respiratory diseases 11.4 % vs. 7.9 %. Likewise, the proportion with self-assessed very good or good general health among those affected was also higher in Germany (diabetes 35.8 % vs. 30.7 %, cardiovascular diseases 25.3 % vs. 18.9 %, chronic respiratory diseases 44.7 % vs. 41.9 %). For limitations in everyday activities, higher proportions were found in Germany for diabetes (65.6 % vs. 60.6 %) and chronic respiratory diseases (64.5 % vs. 57.6 %). Germany showed similar gender-, age- and education-specific differences for disease prevalence, but in part less pronounced differences for the indicators of self-assessed health than the European average. Conclusions: Further analysis of the differences for the indicators considered between Germany and the European average and the possible underlying factors, such as differences in prevention, diagnosis, disease severity and care, is required. The educational inequalities observed across Europe suggest considerable potential for promoting health equity.

Abstract Background Increasing evidence points to a relation between cardiometabolic and mental health, but population-based data are scarce. We investigated the association of type 2 diabetes (T2D) risk to general and mental health with a focus on potential differences between women and men. Methods The study population comprised 5,192 adults (18+ years) without known diabetes based on data of the German Health Update (GEDA) 2022. T2D risk was assessed by the German Diabetes Risk Score (GDRS), that estimates the 5-year probability of developing T2D and was categorized into low, still low, elevated, and high risk. Sex-specific Poisson regression analyses were conducted including self-rated health (SRH), self-rated mental health (SRMH), depressive symptoms (PHQ-2) and anxiety symptoms (GAD-2) as dichotomous dependent variables and age, educational level, living alone, region of residence, and social support as covariables. Results Women had a higher prevalence of low T2D risk (66.1%) and a lower prevalence of high T2D risk (9.4 %) than men (55.3% vs. 16.3%). Compared to those with low T2D risk, women and men with a high T2D risk were less likely to report very good/good SRH (women: prevalence ratio: 0.63; 95% confidence interval: 0.51-0.79; men: 0.69; 0.57-0.84) or excellent/very good SRMH (women: 0.53, 0.39-0.73; men: 0.85, 0.63-1.15). Further, those with a high T2D risk had a higher risk of depressive symptoms (women: 1.71, 1.05-2.81; men: 2.23, 1.22-4.05) and anxiety symptoms (women: 1.84, 1.03-3.29; men: 2.73, 1.09-6.81). No statistically significant interactions between sex and T2D risk were observed regarding the included health outcomes. Conclusions A high T2D risk is associated with a lower probability of a favourable SRH and SRMH and a higher risk of depressive and anxiety symptoms in men and women. The underlying mechanisms need further identification, in order to design synergistically beneficial health promotion for cardiometabolic and mental health. Key messages • No sex-specific differences in general and mental health were found in people at high T2D risk. • Further research is needed to identify the underlying mechanism to improve general and mental health.

Zusammenfassung Hintergrund Das frühere Versterben in sozioökonomisch benachteiligten Bevölkerungsgruppen stellt eine extreme Ausprägungsform gesundheitlicher Ungleichheit dar. Diese Studie untersucht das Ausmaß, die zeitliche Entwicklung und Reduktionspotenziale regionaler sozioökonomischer Ungleichheiten in der vorzeitigen Sterblichkeit in Deutschland. Methoden Bundesweite Daten der amtlichen Todesursachenstatistik wurden auf Stadt- und Landkreisebene mit amtlichen Bevölkerungsdaten und dem „German Index of Socioeconomic Deprivation“ (GISD) verknüpft. Altersstandardisierte Mortalitätsraten für unter 75-Jährige wurden stratifiziert nach Geschlecht und Deprivationsquintil berechnet. In einer What-if-Analyse wurde anhand kontrafaktischer Szenarien berechnet, wie viel niedriger die vorzeitige Sterblichkeit insgesamt läge, wenn sozioökonomische Mortalitätsungleichheiten verringert würden. Ergebnisse Männer und Frauen im höchsten Deprivationsquintil hatten ein 43 % bzw. 33 % höheres Risiko, vorzeitig zu versterben, als Gleichaltrige im niedrigsten Deprivationsquintil. Höhere Mortalitätsraten mit steigender Deprivation zeigten sich für die Herz-Kreislauf- und Krebsmortalität, aber auch für andere Todesursachen. Die sozioökonomischen Mortalitätsungleichheiten nahmen bereits vor der COVID-19-Pandemie zu und verschärften sich in den ersten Jahren der Pandemie weiter. Hätten alle Regionen die gleiche Mortalität wie jene im niedrigsten Deprivationsquintil, läge die vorzeitige Sterblichkeit insgesamt 13 % niedriger. Diskussion Die zunehmende Ungleichheit in der vorzeitigen Sterblichkeit zwischen deprivierten und wohlhabenden Regionen verdeutlicht, dass die Herstellung gleichwertiger Lebensverhältnisse im Bundesgebiet auch für die Verringerung der gesundheitlichen Ungleichheit ein wichtiges Handlungsfeld darstellt.

OBJECTIVE:Population-based studies of reasons for not participating in diabetes self-management education (DSME) are scarce. Therefore, we investigated what sociodemographic and disease-related factors are associated with participation in DSME, the reasons for not participating in DSME and how participants evaluate DSME. RESEARCH DESIGN AND METHODS:We used data from the nationwide survey "Disease knowledge and information needs-Diabetes mellitus 2017", which included a total of 1396 participants diagnosed with diabetes mellitus (diabetes; n = 394 DSME-participants, n = 1002 DSME-never-participants). Analyses used weighted logistic or multinominal regression analyses with bivariate and multivariable approaches. RESULTS:Participants were more likely to attend DSME if they had a medium (OR 1.82 [95%CI 1.21-2.73]),or high (OR 2.04 [95%CI 1.30-3.21]) level of education, had type 1 diabetes (OR 2.46 [1.24-4.90]) and insulin treatment (OR 1.96 [95%CI 1.33-2.90]). Participants were less likely to attend DSME if they lived in East Germany (OR 0.57 [95%CI 0.39-0.83]), had diabetes for >2 to 5 years (OR 0.52 [95%CI 0.31-0.88] compared to >5 years), did not agree that diabetes is a lifelong disease (OR 0.30 [95%CI 0.15-0.62], had never been encouraged by their physician to attend DSME (OR 0.19 [95%CI 0.13-0.27]) and were not familiar with disease management programs (OR 0.67 [95%CI 0.47-0.96]). The main reasons for non-participation were participant's personal perception that DSME was not necessary (26.6%), followed by lack of recommendation from treating physician (25.7%) and lack of information on DSME (20.7%). DSME-participants found DSME more helpful if they had a medium educational level (OR 2.06 [95%CI 1.10-3.89] ref: low level of education) and less helpful if they were never encouraged by their treatment team (OR 0.46 [95%CI 0.26-0.82]). DISCUSSION:Professionals treating persons with diabetes should encourage their patients to attend DSME and underline that diabetes is a lifelong disease. Overall, the majority of DSME participants rated DSME as helpful.

Menschen mit Diabetes sollten aktiv in ihre Behandlung eingebunden werden. Daher ist ihre Perspektive auf Komponenten der Versorgungsqualität in der Interaktion mit dem Behandlungsteam bedeutsam, z. B. in Bezug auf das Festlegen individueller Therapieziele. Im Rahmen einer bundesweiten, bevölkerungsbezogenen Befragung wurde die Versorgungsqualität aus der Perspektive von Menschen mit Typ-2-Diabetes ab 45 Jahren erfasst und im Zusammenhang mit soziodemografischen, krankheits- und versorgungsbezogenen Merkmalen analysiert, um daraus Verbesserungspotenziale abzuleiten. Die selbsteingeschätzte Versorgungsqualität wurde mithilfe des 9 Einzelkomponenten umfassenden Befragungsinstruments PACIC-DSF (Patient Assessment of Chronic Illness Care – DAWN short form) ermittelt. Ein höherer Mittelwert des PACIC-DSF-Scores bzw. der 9 Komponenten (Skala jeweils: 1–5) weist auf eine bessere selbsteingeschätzte Versorgungsqualität im letzten Jahr hin. Die Versorgungsqualität des Typ-2-Diabetes wurde insgesamt als moderat eingeschätzt (2,4). Frauen, Menschen ab 80 Jahren und Menschen mit einer Diabetesdauer < 5 Jahren schätzten ihre Versorgungsqualität gegenüber den Vergleichsgruppen weniger gut ein. Eine Schulungsteilnahme, ärztliche diagnostische Maßnahmen, eine Medikation (v. a. Insulin) und Blutzuckerselbstkontrollen (v. a. mit Sensor) gingen mit einer besseren selbsteingeschätzten Versorgungsqualität einher. Mehr als die Hälfte der Befragten berichtete für die meisten PACIC-DSF-Komponenten, z. B. die Ermutigung zu einer Schulung sowie Fragen nach Nebenwirkungen der Medikamente und eigenen Behandlungszielen, diese selten oder nie im letzten Jahr erlebt zu haben. Den Ergebnissen zufolge erscheint eine stärkere Implementation von Komponenten einer patientenzentrierten Behandlung notwendig. Personen mit kurzer Diabetesdauer und ohne Medikation könnten stärker eingebunden werden, z. B. nach ihren Behandlungswünschen gefragt werden. Diabetesschulungen und ärztliche diagnostische Maßnahmen könnten die Versorgungsqualität erhöhen.

Aims The Gompertz law of mortality proclaims that human mortality rates in middle to old ages grow log-linearly with age and this law has been confirmed at multiple instances. We investigated if diabetes mortality in Germany also obeys to the Gompertz law and how this information helps to communicate diabetes mortality more intuitively. Methods We analyzed all statutory health-insured persons in Germany in 2013 that were aged 30 years or older. Deaths in 2014 were recorded and given in 5-year age groups. We fitted weighted linear regression models (separately for females and males and for people with and without diabetes) and additionally computed the probability that a person with diabetes dies before a person of the same age and sex without diabetes, and the “diabetes age”, that is, the additional years of mortality risk added to an individual’s chronological age due to diabetes-related excess mortality. Results We included N = 47,365,120 individuals, 6,541,181 of them with diabetes. In 2014, 763,228 deaths were recorded, among them 288,515 with diabetes. Diabetes mortality followed nearly perfectly Gompertz distributions. The probability that a person with diabetes dies before a person without diabetes was 61.9% for females and 63.3% for males. Conclusions Diabetes mortality for females and males aged 30 years or older in Germany in 2014 followed the Gompertz law of mortality. The survival information of the population with diabetes during a large part of the lifespan can thus be reduced to the two parameters of the Gompertz distribution.

Background: The nationwide study German Health Update (GEDA) 2021/2022-Diabetes was conducted to assess the current healthcare and health situation of adults with diabetes in Germany. Methods: GEDA 2021/2022-Diabetes comprises a sample of adults with diagnosed diabetes from the general population. The analysis focuses on adults aged 45 years and over with type 2 diabetes (N = 1,448) and provides selected indicators on diabetes care as well as mental, social and general health. Results: 87.5 % of participants aged 45 years and over with type 2 diabetes are treated with blood glucose-lowering medication. 36.5 % receive insulin alone or in combination with other antidiabetics; 0.7 % use an insulin pump. Almost 96 % had an HbA1c measurement in the last year and about two thirds each report annual foot and eye examinations, participation in a diabetes self-management education programme and self-monitoring of their feet and of blood glucose (12.0 % with continuous glucose monitoring). On average, the quality of diabetes care is perceived as moderate. 23.8 % rate their mental health as excellent/very good. More than a tenth each have anxiety or depressive symptoms and feelings of loneliness. Half rate their general health as very good/good. Conclusions: There is a potential for improvement in the quality of diabetes care and the mental and physical health of adults with type 2 diabetes.

Abstract Background We examined the prevalence of major NCD groups (diabetes, chronic respiratory diseases (CRD) and cardiovascular diseases (CVD)) as well as self-rated health (SRH) and health-related limitation in everyday activities among those with one of these NCD in Germany and Europe (average of 28 European countries (EU-28)). Methods Data was derived from the European Health Interview Survey (EHIS-3, 2019/20). Health indicators were: self-reported diabetes, CRD and CVD in the past 12 months; SRH (very good/good vs. fair, bad, very bad) and health-related limitations in usual everyday activities for at least 6 months (severe/moderate vs. no limitation). Educational level was operationalized via ISCED-11. Analyses are age-standardized to the European Standard Population 2013. Results Prevalence of major NCD in Germany were statistically significantly higher than in the EU-28: diabetes 8.1% vs. 7.1%, CRD 11.2% vs. 7.9% and CVD 6.6% vs. 5.4%. Highest prevalence was observed in the lowest educational group and lowest prevalence in the highest educational group for all of these NCD in Germany as well as in the EU-28. The proportion of a very good/good SRH among people having one of these NCD was higher in Germany compared to the EU-28: for people with diabetes 35.8% vs. 31.0%, with CRD 45.6% vs. 42.9% and with CVD 25.3% vs.19.1%. The proportion of health-related limitations among those having at least one of these NCD varied according to educational level in Germany as well as in the EU-28 with a higher prevalence among people with low educational level compared to high. Conclusions Even though prevalence of these NCD were higher in Germany, a higher proportion of very good/good SRH for people with one of these NCD was observed compared to the EU-28. Many factors such as severity of disease, disease management and care could explain this difference. Social inequalities were present not only in the prevalence of NCD but also in health-related limitations in Germany and Europe. Key messages • Prevalence of self-reported major NCD were higher in Germany while self-rated health among people having NCD was better than in Europe. • Health equity interventions in Germany and Europe are necessary.

Purpose: Fear of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and lockdown measures may have an impact on health care utilization particularly for people with chronic diseases. We investigated changes in outpatient utilization behavior in pandemic phases among people with selected chronic diseases in Germany. Methods: The nationwide population-based telephone surveys German Health Update (GEDA) 2019/2020 (April 2019 to September 2020) and GEDA 2021 (July to December 2021) covered 4 out of 7 pandemic phases from the pre-pandemic to the 4th pandemic wave. Data on hypertension, diabetes and major cardiovascular diseases (CVD) in the past 12 months and visiting a general practitioner (GP) or a specialist (excluding dentist) in the past 4 weeks was collected using a standardized questionnaire. Proportions and odds ratios were derived from logistic regression models adjusted for age, sex, education and federal states. Results: Among 27,967 participants aged >= 16 years, 8,449, 2,497 and 1,136 individuals had hypertension, diabetes and major CVD. Participants with these chronic diseases visited a GP or specialist significantly more often than the overall study population, irrespective of pandemic phases. Compared to the pre-pandemic phase, a significant reduction in specialist-visiting was found in the first pandemic wave among people with hypertension (34.3% vs 24.1%), diabetes (39.5% vs 25.5%) and major CVD (41.9% vs 25.6%). GP-visiting was lower only among people with hypertension (53.0% vs 46.0%). No difference in GP or specialist visiting was found in the 4th pandemic wave compared to the pre-pandemic phase. Conclusion: The observed decrease particularly in specialist utilization among people with the selected chronic diseases at the beginning of the pandemic was not observed for the second half of 2021 despite the ongoing pandemic. Further studies are required to examine whether the temporary changes in the utilization of ambulatory health care have affected the disease management of people with chronic diseases.