1. Management of diabetes mellitus and its complications – comparative study - between a Romanian and a German Diabetes Care Center Author: Feier Ingrid Coordinator: Dr. Szabó Mónika

2. Background In 2013 382 million people worldwide have diabetes (IDF), 592 million in 2035 7. leading cause of death in the world in 2030 (WHO) Leading cause of blindness, amputation and kidney failure (WHO) The organization of diabetes care is crucial in the management

3. Guidelines for the optimal management - valid equally for every country in the European Union

4. Management of diabetes - similarities - 1.HbA1c: Measurement frequency - at least 2 times each year in patients who are meeting treatment targets and have stable glycemic control - quarterly in patients whose therapy has changed or who are not meeting glycemic targets Value - < 7 % 2.Visit frequencies: - 3-4 times/year 3.Complication screening - 3-4 times/year 4.Coverage of diabetes care and medication - For free

5. Management of diabetes - differences - RomaniaGermany Structure of Diabetes Care Center 1 doctor+1 assistant/1600 patients 1 doctor+2 diabetes educators+2 diabetes- assistants+2 „wound- assistant“/1400 patients Structured education-Individual, group education/training sessions Test coverage100 tests/3 months for patients treated with insulin OAD (insulinotrop): 50 tests/3 months Insulin: ICT: 400 tests/3 months CT: 200 tests/3 months BOT: 100 tests/3 months Financial background of the patients lowerhigher

6. Objective To investigate the differences and their consequences in diabetes management in a Romanian and German Day Care Center

7. Material and Method Patients suffering from type 2 diabetes: 100 from Târgu Mures, Romania 100 from Mülheim, Germany We compared following parameters: Glycated hemoglobin Body mass index Waist circumference Diabetic polyneuropathy, retinopathy, nephropathy Stroke, coronary heart disease (CHD) Health education, training sessions

8. Results

10. P=NS 106,84 30,17

11. HbA1c

12. Microvascular complications of diabetes 73% 22% 54% 7%8%

13. Macrovascular complications of diabetes 5%

14. Health education, training sessions

15. Conclusions No significant differences concerning HbA1c, waist circumference, BMI The prevalence of microvascular complications (polyneuropathy, retinopathy, nephropathy) in the Romanian group was significantly higher inadequate training and monitoring of HbA1c (HbA1c was measured 3 times more frequently in the German group) Macrovascular complications: Stroke -> same prevalence in both groups, CHD (coronary heart disease ) -> significantly higher in the Romanian group Importance of diabetes educators/ assistants

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