Andrea Teti

Selecting and defining indicators for diabetes surveillance in Germany

Mainly because of the large number of people affected and associated significant health policy implications, the Robert Koch Institute (RKI) is developing a public health surveillance system using diabetes as an example. In a first step to ensure long-term and comparable data collection and establish efficient surveillance structures, the RKI has defined a set of relevant indicators for diabetes surveillance. An extensive review of the available literature followed by a structured process of consensus provided the basis for a harmonised set of 30 core and 10 supplementary indicators. They correspond to the following four fields of activity: (1) reducing diabetes risk, (2) improving diabetes early detection and treatment, (3) reducing diabetes complications, (4) reducing the disease burden and overall costs of the disease. In future, in addition to the primary data provided by RKI health monitoring diabetes surveillance needs to also consider the results from secondary data sources. Currently, barriers to accessing this data remain, which will have to be overcome, and gaps in the data closed. The RKI intentends to continuously update this set of indicators and at some point apply it also to further chronic diseases with high public health relevance. PUBLIC HEALTH · SURVEILLANCE · DIABETES MELLITUS · INDICATORS · NCD

Feasibility of the Factorial Survey Method in Aging Research: Consistency Effects Among Older Respondents.

Background: The factorial survey (FS) method is increasingly used in the social sciences. It is particularly suitable for studying decision situations that are difficult to assess empirically. This article evaluates whether the FS method is suitable for studying decisions in gerontological research. Methods: The present article draws on data from the Housing Opportunities & Mobility in the Elderly study. A total of 103 respondents (between 55 and 90 years) were asked to make hypothetical relocation decisions. The consistency of these responses was assessed as a function of respondents’ age, gender, immigration background, education, household income, employment status, and intention to move. Results: No significant differences in response consistency were attributable to age, gender, education, or immigration background. The personal relevance of the survey topic was positively related to response consistency in multiperson households. Conclusion: FS method can, under certain methodological conditions, be used among older adults especially when the topic of the survey is relevant to their daily lives.

Diabetes-Surveillance in Deutschland – Auswahl und Definition von Indikatoren

Vor dem Hintergrund einer hohen Anzahl Betroffener und der damit verbundenen gesundheitspolitischen Bedeutung wurde am Beispiel Diabetes mellitus mit dem Aufbau einer Public-Health-Surveillance am Robert Koch-Institut (RKI) begonnen. Für eine nachhaltige und vergleichbare Datenlage und zur Etablierung effizienter SurveillanceStrukturen wurde zunächst ein Set relevanter Indikatoren für die Diabetes-Surveillance definiert. Basierend auf umfangreichen Literaturrecherchen und anhand eines strukturierten Konsensusprozesses entstand ein abgestimmtes Indikatorenset, bestehend aus 30 Kernund 10 Zusatzindikatoren. Diese können den folgenden vier Handlungsfeldern zugeordnet werden: (1) Diabetes-Risiko reduzieren, (2) Diabetes-Früherkennung und Behandlung verbessern, (3) Diabetes-Komplikationen reduzieren, (4) Krankheitslast und Krankheitskosten senken. Neben den Primärdaten des RKI-Gesundheitsmonitorings sollen zukünftig auch Ergebnisse aus verfügbaren Sekundärdatenquellen in die Diabetes-Surveillance mit einfließen. Hierzu müssen die teilweise noch existierenden Barrieren bei der Nutzung vorhandener Datenquellen abgebaut sowie bestehende Datenlücken geschlossen werden. Perspektivisch soll das Indikatorenset kontinuierlich angepasst und auf weitere chronische Erkrankungen mit hoher Public-Health-Relevanz übertragen werden. PUBLIC HEALTH · SURVEILLANCE · DIABETES MELLITUS · INDIKATOREN · NCD

Erste Ergebnisse der Studie „Krankheitswissen und Informationsbedarfe – Diabetes mellitus (2017)“

Bislang ist wenig dazu bekannt, was Menschen in Deutschland zum Thema Diabetes wissen, welche Informationen sie sich wünschen, wo sie Informationen suchen und wie sie vorhandene Informationen einschätzen. Das Robert Koch-Institut (RKI) führte mit einem Schwerpunkt auf diesen Fragestellungen im Jahr 2017 den bundesweiten telefonischen Survey „Krankheitswissen und Informationsbedarfe – Diabetes mellitus (2017)“ in der Bevölkerung ab 18 Jahren durch. Insgesamt wurden 2.327 Personen ohne und 1.479 Personen mit diagnostiziertem Diabetes befragt. Erste Ergebnisse zeigen, dass 56,7 % der Befragten ohne Diabetes und 92,8 % der Befragten mit Diabetes ihr Diabeteswissen als sehr gut oder gut einschätzen. Befragte ohne Diabetes empfinden das größte Informationsbedürfnis zum Thema „Lebensstilanpassungen, Gesundheitsförderung und Prävention“, Befragte mit Diabetes zum Thema „Behandlung und Therapie“. Fast ein Drittel der Befragten ohne Diabetes hat sich schon einmal aktiv zu Diabetes informiert, am häufigsten über gedruckte Informationen. Für Menschen mit Diabetes ist die behandelnde (Haus-)Ärztin beziehungsweise der behandelnde (Haus-)Arzt die am häufigsten genannte Informationsquelle. In beiden Gruppen findet es etwa die Hälfte der Befragten schwierig, die Vertrauenswürdigkeit von Informationen zu Diabetes in den Medien einzuschätzen. Die Ergebnisse der Studie gehen in die vom RKI koordinierte Nationale Diabetes-Surveillance ein und werden von der Bundeszentrale für gesundheitliche Aufklärung zur Entwicklung von Strategien für eine verbesserte Information der Bevölkerung zum Thema Diabetes mellitus genutzt. DIABETES MELLITUS · TELEFONSURVEY · KRANKHEITSWISSEN · KRANKHEITSWAHRNEHMUNG · INFORMATIONSVERHALTEN

Diabetes Surveillance in Germany – Background, concept andprospects

Diabetes mellitus is a chronic disease that is associated with serious health problems and high costs. According to estimates gained from nationally representative health surveys conducted by the Robert Koch Institute (RKI), 4.6 million adults aged 18 to 79 suffer from diabetes in Germany. In addition, around 1.3 million adults have undetected diabetes. A surveillance system is currently being established at the RKI in order to gather the data sources available on diabetes in Germany and to provide reliable and comparable findings on time trends covering the frequency, progress of treatment, prevention and care of the disease. Next to identifying trends, diabetes surveillance also needs to detect differences in epidemiology that are related to social status or geographic region. Diabetes surveillance at the RKI is being undertaken in close cooperation with stakeholders involved in science, health-care provision, health policy and health-system self-governance. Furthermore, its progress is accompanied by an interdisciplinary scientific advisory board. Diabetes surveillance involves the following key elements: 1) the development of a research-based conceptual framework that uses indicators to appropriately measure developments in the disease; 2) the establishment of standards for the use of existing data sources and the identification of barriers to data usage and gaps in the data; and 3) the implementation of focused health reporting that is geared towards the target group. In addition to policy consultations, diabetes surveillance must guarantee the provision of timely and continuous information to the public together with the Federal Agency for Health Education. The implementation of a diabetes surveillance in Germany should act as a model and serve as a basis with which to establish the surveillance of other noncommunicable diseases. In principle, indicator-based diabetes monitoring at the population level can be viewed as providing the body for evidence-based policy consultation and focused health policy. In turn, this should enable the implementation of effective disease prevention measures and high-quality care for all groups within the population. DIABETES MELLITUS · HEALTH MONITORING · DIABETES SURVEILLANCE · HEALTH REPORTING · PREVENTION

Proceedings of the International Workshop ‘Development of a National Diabetes Surveillance System in Germany – Core Indicators and Conceptual Framework’

equal contribution Diabetes mellitus is a chronic metabolic disease approximately affecting 6 million adults in Germany and more than 300 million people worldwide [1]. On average, nearly 8% of adults in high-income countries and 10% in middle or low-income countries have diabetes [2]. Patients with diabetes have an increased risk for cardiovascular diseases, renal impairments, blindness, peripheral neuropathy and amputations of the lower leg and for excess mortality [3]. Unknown or insufficiently treated diabetes bears a particularly high risk for longterm complications. Diabetes is associated with a high burden of disease and costs for individuals as well as for the health care system and society as a whole. Treatment and care of diabetes led to costs of almost 48 billion euros in Germany in 2009 [4]. Against this background, the Robert Koch Institute RKI (the German National Public Health Institute) was commissioned by the Federal Ministry of Health to develop a National Diabetes Surveillance System for Germany. In order to integrate existing international expertise in the development process, the RKI organized an international workshop with experts from the U.S., Canada and Europe. The Workshop ‘Development of a National Diabetes Surveillance System in Germany – Core Indicators and Conceptual Framework’ was held in Berlin, Germany on July 11–12, 2016 and pursued the following goals: (a) to share experience on existing surveillance systems and diabetes registries (b) to refine the conceptual framework of the diabetes surveillance in Germany and for harmonization of core indictors and (c) to strengthen international collaboration. Experts were invited to present their specific experiences in planning and implementing diabetes registries or surveillance approaches (S1-S6). The conceptual framework and aims of the diabetes surveillance project in Germany were presented in the first workshop contribution by Christa Scheidt-Nave, Robert Koch-institute RKI, Berlin Germany (S1). The U.S. experience in the gradually implementation over the last 20 years of a National Diabetes Surveillance System (USDSS) was presented by Edward Gregg, epidemiologist at the CDC in Atlanta (S2). How Denmark’s health care system profits from the opportunity for