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Improvements in Diabetes Care: International Experiences |

Health Care for Persons with Non-Insulin-dependent Diabetes Mellitus: The German Experience

Michael Berger, MD; Viktor Jorgens, MD; and Gunter Flatten, MD
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From the Department of Metabolic Diseases and Nutrition (World Health Organization Collaborating Center for Diabetes), Heinrich-Heine University, Dusseldorf, Germany; and the Central Institute of Ambulatory Health Care for the Federal Republic of Germany, Cologne, Germany. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “Risks and Benefits of Intensive Management in Non-Insulin-dependent Diabetes Mellitus: The Fifth Regenstrief Conference.” To view a complete list of the articles included in this supplement, please view its Table of Contents. Grant Support: By the Peter Klockner Foundation, Duisburg, Germany (grants to MB). Requests for Reprints: Professor Michael Berger, MD, Department of Metabolic Diseases and Nutrition, Heinrich-Heine University-Dusseldorf, Moorenstrasse 5, 40225 Dusseldorf, Germany. Current Author Addresses: Drs. Berger and Jorgens: Department of Metabolic Diseases and Nutrition, Heinrich-Heine University-Dusseldorf, Moorenstrasse 5, 40225 Dusseldorf, Germany.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(1_Part_2):153-155. doi:10.7326/0003-4819-124-1_Part_2-199601011-00014
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A structured treatment and education program for patients with non–insulin-dependent diabetes mellitus (NIDDM) who are not taking insulin was developed, evaluated, and implemented at the primary health care level throughout Germany. The program is based on the definition of individual and pragmatic therapeutic goals for each patient, primarily using nondrug treatment, which includes systematic glycosuria self-monitoring by the patients and four structured sessions of group education held in a general practitioner's office. After documentation of the program's efficacy in a randomized, controlled trial and several pilot projects, the program has been officially incorporated into the general German health care scheme and includes payment to practicing physicians for each patient treated. More than 12 500 primary health care physicians have participated in special 2-day postgraduate courses given by diabetologists; these courses are a precondition to participating in the program. As part of the primary health care scheme, the NIDDM program will be continuously monitored for quality control and efficiency. Currently, similar structured treatment and education programs targeted to primary health care physicians are being introduced for both insulin-treated NIDDM and arterial hypertension.





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