According to latest International Diabetes Federation IDF estimations more than million people suffered from diabetes worldwide inand the number of T2DM patients will reach million by . The number of patients increasing continuously as population grows and societies grow old. The most important risk factors behind this epidemiological trend are urbanization, obesity and physical inactivity.
The estimations for the T2DM prevalence in Hungary show considerable heterogeneity. The routine data collection systems, which register different prevalences, are the following: Hungarian Central Statistical Office HCSO collects data on diabetes mellitus prevalence without having a formal case definition.
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The general practitioners are obliged to report the age and sex specific number of cared patients in every second year. The national report on diabetes mellitus prevalence is published by HCSO biannually. Nowadays, 11 counties are involved and more than GPs.
It monitors incidences and prevalences of diseases with great public health importance with declared case definition and quality checking system in a sample representative by age and gender for the adult Hungarian population.
Diabetes is one of the monitored diseases.
According to specification, - 4 - 5 it should be repeated every five years, to create a statistical dataset, from which predefined health-indicators could be calculated. Eurostat experts designed the insulin dependent diabetes mellitus type 2 icd 10 questionnaires to collect self-assessed data.
The survey was conducted on a representative sample. Comparing the data, collected in in these diabetes-related data collection systems, reliable system e. The estimations for younger age groups do not differ from each other . Figure 1 Figure 1. The corresponding incidences were 0. It was in harmony with a survey based diabetes mellitus prevalence, which estimated the prevalence of diabetes mellitus among year-old population as 7.
These observations show that although T2DM occurrence is not neglectable in younger age groups, a sharp increase can be detected from the age of Figure 2 - 5 - 6 Figure 2. Costs of drug treatment and hospitalizations have 1 kg cukor hány liter large impact on economic burden.
the International Diabetes Federation - IDF DIABETES ATLAS
Beside the huge economic burden the quality of life also decreases due to complications and comorbidities of T2DM . Most of this burden is related to the non-fatal major adverse outcomes blindness, neuropathy, renal failure and loss of a toe or footand nearly half of T2DM patients die of cardiovascular diseases .
Diabetes mellitus related death is a significant part of premature mortality. In Hungary it was 1. Clear and convincing evidences exist that early diagnosis and the appropriate glucose control play a key role in this respect .
In many countries certain data are completely lacking, others are quite old . Hungary is not an exception in this respect, unfortunately. The prevalence of peripheral artery disease was lower as well The difference was slighter, but Hungary had still better values by coronary heart disease By stroke prevalence Hungary had higher values 7.
This set involves four process indicators annual HbA1c testing, annual LDL cholesterol testing, annual screening for nephropathy and annual eye examinationtwo proximal outcome indicators HbA1c control, LDL cholesterol control and three distal outcome indicators lower extremity amputation rates, kidney disease in persons with diabetes mellitus, cardiovascular mortality in patients with diabetes mellitus .
Many countries try - 7 - 8 to implement as much OECD indicators as they can afford , but there are many countries with survey-based programs, in which only process indicators are used . Establishment of a monitoring system is essential for this goal.
These indicators are the referral rates of adult diabetes mellitus patients in annual HbA1c check HC and annual ophthalmologic examination OE. GPs are evaluated and partly financed based on these indicators . HDA recommends patients insulin dependent diabetes mellitus type 2 icd 10 examination once a year before manifestation of retinopathy.
Ophthalmologists decide the frequency of control examinations whether diabetic retinopathy is presented . According to HDA recommendations HbA1c test is suggested at least 4 times a year for patients treated with insulin and 2 times a year in other cases . Despite of the international usage of outcome indicators in monitoring, and the fact that the physicians evaluate the patients status routinely by HbA1c level, only process indicators are used in Hungary for evaluation and financing.
HbA1c level as an outcome indicator, to measure the effectiveness of glycemic control is not applied by the HNHIF monitoring. Current guideline on diagnosing, screening and treating diabetes of HDA is in harmony with international recommendations. However, in when the data collection of our study had been carried out- the recommended target level for HbA1c was 6. Nowadays, recommendations suggest a target range of 6. The primary level of prevention is the elimination of risk factors to prevent the disease development.
This primary prevention uses, inter alia, health promotion tools e.
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The secondary level of prevention is screening. It could result early diagnosis in preclinical phase, in order to the start the treatment as soon as possible.
Tertiary prevention means proper care for diagnosed patients to prevent or at least postpone the development of complications for a better quality of life. Figure 3 There is no doubt that coordinated teamwork is a main part of proper care. In addition to the general practitioners, dieticians, physiotherapists, health psychologists or mental health psychologists, nurses and public health professionals play key role in proper care.
In the time of our study data collectionthe guidelines advised diet therapy and physical activity as the first step of diabetes care  in cases of non-serious clinical status [32, ].
Figure 3. Development and progress of type 2 diabetes mellitus with factors influencing the prognosis 10 Objectives Our objective was to investigate the efficiency of Hungarian T2DM care.
The program was started inby the School of Public Health, University of Debrecen, aimed at continuously monitoring prevalences and incidences of diseases with major public health importance hypertension, stroke, diabetes mellitus, ischemic heart disease, acute myocardial infarction, lung cancer, breast cancer, cervical cancer, colon cancer, prostate cancer on a representative national sample .
On case report forms, the practice code of the GP was recorded. Patients of the GP were coded by unique code, without names, to assure anonymity.
Only GPs can identify their patients. GPs did physical examination, took blood sample for laboratory tests and measured the blood pressures of patients. The results were recorded on CRFs with additional demographic information. Selfadministered questionnaires on life-style were filled out by a kezelés az 1. típusú diabétesz tibetben patients .
Global and regional diabetes prevalence estimates for and projections for and results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. Changes in features of diabetes care in Hungary in the period of years —
All the statistical analyses were performed by Stata version 10 . Our survey was approved by the Ethics Committee of University of Debrecen and participants gave informed consent. Sampling was performed from persons, who suffered from T2DM among them according to GPMSSP data at 31 December in Planned sample size was Sample was randomly selected from the source population which was stratified by age and gender. During analyses the numbers of patients differ from each other as we excluded the incomplete records in order to get proper results.
Completeness of records had been checked before insulin dependent diabetes mellitus type 2 icd 10 13 analysis and useful records had been selected. Exclusion of non-complete records resulted different response rates in different analyses.
Data collection Case report forms CRF were filled out by GPs, on which demographic data of the patients age and genderresults of physical examination blood pressure was measured by GPs under standard conditionsinformation on complications and comorbidities hypertension, lipid metabolism insulin dependent diabetes mellitus type 2 icd 10, obesity, other ischemic heart disease, peripheral artery disease, retinopathy, neuropathy, nephropathy, stroke, AMIapplied treatment non-pharmacological, OADs, insulin, pharmacological and non-pharmacological changes, cause of changeinformation on control examinations and on the compliance of the patients were recorded.
For checking the effectiveness of treatment fasting blood glucose and HbA1c were measured. Other parameters which are in association with cardiovascular risk were also measured CRP, creatinine, lipid profile. For laboratory examinations 6 ml fasting blood was taken and capillary blood for HbA1c check.
Samples were transferred to accredited facilities within 3 hours. Self-administrated questionnaires were filled out by the patients, in which questions were asked according to perceived health, eating habits, physical activity, smoking, alcohol consumption, education, social-economic-status, occupation, disability, family history T2DM, cardiovascular diseasesgestational diabetes, birth weight.
On fűszereket a cukorbetegség kezelésében basis of educational level, three groups were created. Patients who had primary education level were in the first group, the second group contained patients with secondary education level and in the third group there were patients with tertiary education level college or university.
Two categories were defined on the basis of marital status. The first one contained single patients while in the second group there were patients who had had a relationship. In the time of the study, Hungarian protocols followed the former IDF guidelines with the target level of 6. The effect of gender, age, level of education, marital status, duration of T2DM, and comorbidities on reaching target HbA1c value, attending annual HC and OE has been quantified by multivariate logistic regression modeling.
We also calculated the prevalences of comorbidities, by gender and two age groupsX. Population-based estimations were calculated on the absolute number of comorbidities among Hungarian T2DM patients above The steps of population based estimation: 1.
Mid-year population of was available at Hungarian A kezelés népi gyógyszer a cukorbetegség Statistical Office.
According to these data, we were able to calculate strata-specific age and gender estimated absulute number of cases. In the evaluation of the change of lethal complications occurrence, the GPMSSP data for two time periods were compared: before and after We collated T2DM patients and calculated gender- and age-specific 2 year cumulative incidences 15 for AMI and stroke, combining 4 year data.
Reference period was the 4 year period before to get the expected numbers. The age and gender standardized relative incidence of AMI and stroke among T2DM patients above 50 observed in periods of to and to was evaluated finally. Proportions of patients having HbA1c below target level were calculated in different sociodemographic strata. In the time of our survey the cut-off point for HbA1c was 6. Multivariate logistic regression model was defined to analyze the association between participation in annual control examinations HC, OE and exceeding the target HbA1c value.
The sample had been stratified by presence of retinopathy. The diagnosis of retinopathy had been confirmed by ophthalmologist. The history of OE was considered as positive if patients had been investigated within 12 months. The gender and age of GPs had been registered as well. The RRs for complication check have been calculated for different socio-demographic strata.