[Structured concept for the establishment of a broad and ambulatory care of patients with type 2 diabetes: one-year evaluation of a regional teaching organization]. / Strukturkonzept zur Etablierung einer flächendeckenden ambulanten Versorgung von Patienten mit Typ-2-Diabetes. Ein-Jahres-Evaluation eines regionalen Schulungsvereins.

BACKGROUND: The increasing prevalence of diabetes mellitus and its long-term complications are associated with an expanding social medical problem. In order to originate an established teaching and training program on a physician-based level in short time, three specialist diabetes centers from Lübeck transferred their concept to a diabetes organization based on 17 physicians who had only rarely undertaken any diabetes teaching before. We investigated the achievement and effectiveness of this concept in a prospective multicenter evaluation one year after the patients had received structured diabetes teaching by the organization. PATIENTS AND METHODS: Physicians and their teaching staff were trained by the specialists from the diabetes centers according to an official agreement. Patients were treated by each practice, while the diabetes teaching was done centrally by the organization through a diabetes assistant/dietician based on a modified official diabetes teaching and training program (ZI-program). 230 of 250 patients (120 male, 110 female) were reinvestigated one year after they had received the teaching. The group consisted of 179 non-insulin-treated (NIB; 94 via physicians, 85 via specialists) and 51 insulin-treated (IB; 19 via physicians, 32 via specialists) participants. RESULTS: The average age of NIB was 60.4+/-9.8 years, while IBs were 68.8+/-7.3 years old. HbA (1c) values were reduced in both groups, NIB and IB, by approximately 1% (NIB: 7.59+/-1.97% to 6.59+/-1.84%; IB: 8.47+/-1.35% to 7,36+/-1,38 %; p < 0,001). In the NIB-group the BMI was reduced by 0,64+/-0,14 kg x m (-2), whereas it was increased in the IB-group by 0.33+/-0.24 kg x m(-2) (NIB: 30.55+/-0.40 to 29.91+/-0.39 kg x m(-2), p < 0.001; IB: 28.83+/-0.74 to 29.16+/-0.75 kg x m(-2), p = 0.82). CONCLUSION: The transfer of established teaching and training concepts of specialist diabetes centers to a newly founded, physician-based diabetes organization resulted in a broad, effective and long-lasting medical care of patients with type 2 diabetics treated without or with insulin. The results are superior to those of other evaluations based on diabetes training ZI-programs.

[Frequencies of red cell enzyme polymorphisms acP, ADA, AK, EsD, 6-PGD, and PGM1 determined by parallel investigations of Turks and Germans living in the Lübeck area (author's transl)]. / Frequenzen von Enzymmerkmalen der Systeme acP, ADA, AK, EsD, 6-PGD und PGM1 parallel ermittelt für Türken und Deutsche im Raum Lübeck.

Gene frequencies for enzyme polymorphisms in the acP, ADA, AK, EsD, 6-PGD, and PGM1 systems were determined by a random sample (n = 281-556-575) Turks living in Lübeck. The results were compared with those of a parallel inquiry on Germans from Lübeck. The following gene frequencies were detected: (table: see text).