Hospitalizations and amputations for diabetes mellitus-trends and small-area variation in Germany

BackgroundHospitalizations and lower limb amputations related to diabetes mellitus (DM) are considered to be potentially avoidable. Appropriate outpatient care of diabetes prevents complications. Rates on potentially avoidable hospitalizations for diabetes are core indicators of the German diabetes surveillance program. International comparisons showed high hospitalization rates in Germany for both indicators.ObjectivesThe objective of this analysis is to describe time trends on hospitalizations and inpatient lower limb amputations (major amputations) for DM. Furthermore, we analyze small area variations.Materials and methodsBased on the German diagnosis related groups (DRGs) dataset we calculated age-standardized rates covering 2005-2015. Calculations rely on the Organisation for Economic Co-operation and Development (OECD) indicator definitions. Time trends are obtained by linear regression modelling. We also stratified into age groups and analyzed 2015 small-area variations using age-adjusted rates.ResultsCrude hospitalization rates were 310admissions per 100,000inhabitants in men (amputation rate: 15.6) and 216 admissions per 100,000inhabitants in women (amputation rate: 7.1) in 2015. Age-adjusted hospitalizations and amputations rates in women decreased over time (10.3 and 1.2cases per 100,000inhabitants and year, respectively). In men, the amputation rate decreased significantly (1.5cases per 100,000inhabitants and year). We found higher rates for men than for women in almost all age categories. In eastern Germany and parts of Bavaria and North Rhine-Westphalia rates are particularly high.ConclusionsAdecrease in hospitalization rates may indicate improvements in ambulatory diabetes care over time. Future studies should consider age-specific differences and small-area variations.