Age at diagnosis of Type 2 diabetes in Germany: a nationwide analysis based on claims data from 69 million people.

AIM: For many European countries, including Germany, no valid estimates are available on age at diagnosis of Type 2 diabetes. Thus, we aimed to estimate the age at diagnosis in Germany. METHODS: Age at diagnosis of Type 2 diabetes in Germany was estimated based on Type 2 diabetes prevalence and incidence and the age distribution of the German population. Age- and sex-specific incidence and prevalence in 2014/2015, based on claims data from statutory health insurance (n= 69 000 000, ~85% of the German population), and the age pyramid for Germany in 2015 were used for the calculation. Age at Type 2 diabetes diagnosis was stratified by sex. CIs were estimated using bootstrap methods. In addition, the age range in which 50% of the population received a diagnosis of Type 2 diabetes was calculated (the interquartile range). RESULTS: The mean ± sd age at Type 2 diabetes diagnosis in 2015 was 61.0 ± 13.4 years (95% CI 60.9-61.0) in men. Women were diagnosed ~2 years later than men (mean age 63.4 ± 14.9 years; 95% CI 63.4-63.5). The age range in which 50% of the population was diagnosed with diabetes was 53-72 years for men and 54-76 years for women. CONCLUSIONS: The sex differences are mainly attributable to a higher incidence of Type 2 diabetes in men than women during middle age and the higher absolute number of women in the older ages. The early age at diabetes diagnosis compared to average life expectancy means that the risk of diabetes-related complications is increased.

Projected number of people with diagnosed Type 2 diabetes in Germany in 2040.

AIMS: To project the number of people with Type 2 diabetes in Germany between 2015 and 2040. METHODS: Based on data from 65 million insurees of the German statutory health insurance, we projected the age-specific prevalence of diabetes using mathematical relations between prevalence, incidence rate and mortality. We compared several scenarios regarding temporal trends in the incidence and mortality rate. The projected age-specific prevalence was applied to the projected age structure of the German population between 2015 and 2040 to calculate the number of people with Type 2 diabetes. RESULTS: Application of current age-specific prevalence estimates to the projected age structure in 2040, although ignoring temporal trends in incidence and mortality, yielded an increase in the number of Type 2 diabetes cases from 6.9 million in 2015 to 8.3 million (+21%) in 2040. More realistic scenarios that account for decreasing mortality rates and different trends in the incidence rates project between 10.7 million (+54%) and 12.3 million (+77%) Type 2 diabetes cases in 2040. CONCLUSIONS: For the first time, we projected the number of future Type 2 diabetes cases for the whole adult population in Germany. The results indicate a relative increase in the number of Type 2 diabetes cases of between 54% and 77% from 2015 to 2040. Temporal trends in the incidence rate are the main drivers of this increase. Simply applying current age-specific prevalence to the future age structure probably underestimates the future number of Type 2 diabetes cases.

Diabetes distress in young adults with early-onset Type 1 diabetes and its prospective relationship with HbA1c and health status.

AIM: This study aimed to determine cross-sectional relationships between diabetes distress and health-related variables, and prospective associations between diabetes distress and future glycaemic control (HbA1c ) and health status among young adults with early-onset Type 1 diabetes. METHODS: Data were collected from a nationwide cohort study of adults whose Type 1 diabetes onset occurred from 0 to 4 years of age during 1993-2002. Questionnaire surveys were conducted in 2012-2013 and 2015-2016 (N = 584). Diabetes distress was assessed via the Problem Areas in Diabetes (PAID) scale (0-100 points), depressive symptoms via the Patient Health Questionnaire-9 (PHQ-9) and health status via the 12-Item Short Form Health Survey (SF-12) questionnaire. Multivariable linear regression analyses were applied to cross-sectional and longitudinal data. RESULTS: In the cross-sectional analyses, higher PAID scale total scores (representing higher distress levels) were observed in women than in men and in participants with more severe depressive symptoms. PAID scores were lower in individuals with better physical and mental health. A 1 mmol/mol increase in HbA1c was associated with a 0.28-point increase [95% confidence interval (95% CI) 0.20, 0.36] in diabetes distress. In longitudinal analyses adjusting for age, sex, socio-economic index and HbA1c at baseline, a 10-point higher PAID score at baseline was associated with a 1.82 mmol/mol higher HbA1c level (95% CI 0.43, 3.20) and a 2.48-point lower SF-12 mental health score (95% CI -3.55, -1.42) three years later. CONCLUSIONS: The cross-sectional and longitudinal analyses results suggest that diabetes distress impairs health-related outcomes in young adults with early-onset diabetes.

Excess mortality for people diagnosed with type 2 diabetes in 2012 - Estimates based on claims data from 70 million Germans.

BACKGROUND AND AIMS: The hazard ratio (HR) is a meaningful concept for comparing the mortality of people with and without type 2 diabetes (T2D). Nevertheless, there is only one German study estimating age-specific HRs. Thus, this study aimed to provide population-wide age-specific HRs for Germany using a novel method based on aggregated population data. METHODS AND RESULTS: We used an illness-death model and published data on T2D prevalence and incidence as well as mortality in the German general population to estimate age-specific HRs in the year 2012 for the population aged 65-90 years. For men, the overall HR was 2.3, which decreased from 2.8 between 65 and 69 years old to 1.6 between 85 and 90 years old. For women, the overall HR was 3.0, which decreased from 4.2 to 1.7 in the same age groups, respectively. CONCLUSION: In Germany, men and women in 2012 with T2D aged 65-90 years experienced a three-to four-fold higher mortality compared to people without T2D, which might indicate that the excess mortality could be higher than in countries with comparable health care systems. Female sex and younger age were associated with higher excess mortality.