The disease management program for patients with type 1 diabetes updated in Germany

The Federal Joint Committee (G-BA) has updated the nationwide requirements for disease management programs (DMP) for patients with type 1 diabetes mellitus. The current DMP contracts must then be adjusted to the new requirements within one year of the decision coming into force. Around 225,000 legally insured patients are currently enrolled in a DMP for type 1 diabetes.

Type 1 diabetes (T1D), also known as juvenile diabetes, is a form of diabetes in which very little or no insulin is produced by the pancreas. Insulin is a hormone required for the body to use blood sugar. If the disease is not treated or is not adequately treated, it can have serious short-term and long-term health consequences, such as blindness or kidney failure. Type 1 diabetes usually debuts in childhood, adolescence or young adulthood. Around 300,000 people in Germany currently have type 1 diabetes, including around 30,000 children and adolescents aged up to 19 years old.

The DMP diabetes mellitus type 1 update relates to individual therapy planning, the aim of which is, in particular, to adjust to a "standard" glucose value and to avoid hypoglycemia. In adults with type 1 diabetes mellitus, an HbA1c value of ≤7.5% (≤58 mmol/mol) should be aimed at as long as no problematic hypoglycemia occurs. In the case of insulin therapy, it is not recommended to primarily use human insulin (instead of insulin analogues). In addition to the intensified insulin therapy (ICT) using manual injection therapy (pen therapy), the continuous subcutaneous insulin infusion (CSII/pump therapy) is now defined as the treatment standard. Concerning lifestyle recommendations, in addition to tobacco consumption, other risks (alcohol consumption, low blood sugar levels in everyday life) were included as of particular importance for patients with type 1 diabetes mellitus. Also, it was added that, under certain conditions, continuous glucose measurement is possible with the help of so-called real-time continuous glucose monitoring (rtCGM) systems. Because of the high likelihood that type 1 diabetes is simultaneously accompanied by autoimmune thyroid disease or celiac disease (gluten intolerance), the DMP has been supplemented by corresponding diagnostic recommendations.

The scientific basis for decisions of the G-BA for now undertaken update was the current guidelines research, developed by the Institute for Quality and Efficiency in Health Care (IQWiG) in 2018. The G-BA last revised the requirements for DMP for type 1 diabetes in 2014.

The G-BA submitted the decision - which also relates to the documentation for DMP type 2 diabetes mellitus - to the Federal Ministry of Health for review. In case of no objection, the new requirements for DMP type 1 diabetes mellitus will take effect on the first day of the quarter following the publication in the Federal Gazette.

At the moment, DMP requirements for rheumatoid arthritis are being developed at the G-BA. The decision is planned for 2020.

The full details in German can be found here.

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