Four-year-old boy with his insulin pump: Not all hospitals would be well prepared for diabetics of this age.
Photo: dpa/Jörg Carstensen
The forthcoming hospital reform is intended to move away from pure economics and flat rates per case to more patient well-being. This is definitely welcomed by the German Diabetes Society (DDG). Because in the previous system, people suffering from diabetes mellitus were given too little consideration, says Baptist Gallwitz from the University Hospital in Tübingen. The internist, diabetologist and DDG board member expects from the reform that the recognition and care of diabetes variants in the clinics will be structured and much better than before. In addition, vulnerable groups should be given special protection, including children and adolescents, patients with type 1 diabetes and the elderly. The whole area must be well funded.
In detail, Gallwitz hopes that a derailed metabolic state, as can occur in diabetics, will be recognized and treated well in future basic care hospitals. It is important for those affected that inpatient and outpatient treatment is much better interlinked than before.
In the past, the flat rates per case, among other things, have led to the closure or downsizing of numerous departments for diabetology and endocrinology in hospitals and university clinics. Endocrinology treats disorders of glands inside the body, including the thyroid, adrenal glands, and pancreas.
However, the number of cases of diabetes in particular will continue to rise. According to one estimate, there could be twelve million patients in the next ten years. Almost nine million people are currently affected. The existing supply structures will be overloaded in the foreseeable future.
More and more patients are arriving in hospitals whose diabetes is only a secondary diagnosis, and in some cases it is only discovered in connection with other complaints. According to the DDG, one in five inpatients already has diabetes. This means that around three million hospital treatments with and because of this disease come together every year. Those affected often have to be hospitalized more often and for longer periods and have more complications than people with a healthy metabolism, as the evaluation of care data from 2015 to 2019 showed.
Even between the ages of 40 and 50, diabetics are three times more likely to have a stroke or heart attack, and their risk of death is also higher than that of non-diabetics. Diabetologists from the DDG, among others, see a lack of knowledge about the condition in the clinics as a problem. Only 17 percent of the houses have sufficiently qualified expertise on how to certify the DDG – and the value is falling.
Uniform standards for examining and treating new admissions for diabetes are also not adhered to across the board. According to a survey, almost every third person with type 1 diabetes has had a bad experience in an uncertified clinic. In particular, people with an insulin pump were left without a contact person for their technology in over 80 percent of the cases.
In order to eliminate these problems, representatives of the DDG are holding talks with members of the Federal Government’s expert commission on hospital reform, among other things. Stephan Petersen from the German Society for Endocrinology warns that emergency rooms should also be able to act in the event of so-called hyperglycemic crises. The blood sugar level is very high, it is an acute emergency. In the worst case, it can lead to a life-threatening diabetic coma.
Petersen also demands that medical students and people in specialist training learn to treat the widespread disease diabetes as a concomitant disease of other diseases. Overall, diabetologists and endocrinologists hope that the reform will strengthen talking medicine for their patients, beyond laboratory parameters and purely technical or surgical procedures.
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