Development of diabetes complications within coordinated and structured primary healthcare (2011-2020): a 10 year retrospective cohort study of over 200,000 patients in Germany.

Abstract

Diabetes is a growing, costly, and potentially preventable public health issue. In 2004, Germany introduced the GP-centred healthcare programme to strengthen primary care. To assess the hazards of the most common diabetes-related complications in patients enrolled in GP-centred healthcare in comparison to usual primary care. A retrospective cohort study based on German claims data (4 million members) from 2011 to 2020. 217,964 patients with diabetes were monitored from 2011-2020. Endpoints were blindness, amputation, myocardial infarction, stroke, coronary heart disease, dialysis, hypoglycaemia and all-case-mortality. Cox proportional-hazards regression models were used for multivariable analysis and adjusted for socio-demographic, practice- and disease-specific characteristics. Compared to usual care (n=98,609 patients), GP-centred healthcare (n=119,355 patients) showed a relative risk reduction of blindness of 12 %, and amputation of 20% over 10 years. The estimated impact of GP-centred healthcare on myocardial infarction, stroke, coronary artery disease, dialysis and mortality is significantly favourable in comparison to usual care. However, the proportional risk of hypoglycaemia (+1.2 %) in the interventional group is higher than in the usual care. Enrolment in GP-centred healthcare appears to result in a consistent reduction of the relative risk of diabetes-related complications over 10 years. The significant difference in contrast to usual care may be explained by robust, structured primary care provision, including the diabetes disease management programme and improved coordination and networking of care within primary and secondary care.