The epidemiologist Dr. Christa Scheidt-Nave leads the development of national diabetes surveillance at the Robert Koch Institute in Berlin. In the interview she explains the goals of the project and addresses the challenges.

>> It is estimated that the number of people with diabetes in Europe will increase by 33 percent by 2035. Where does Germany stand in this field?
Population-based studies on the prevalence of diabetes generally cannot distinguish between the different forms of diabetes. When we talk about diabetes here, we primarily mean type 2 diabetes. Epidemiological modeling by Ralph Brinks and colleagues at the German Diabetes Center in Düsseldorf has also predicted a sharp increase in the number of type 2 diabetes in Germany. Future developments will depend crucially on how successfully the prevention of type 2 diabetes is implemented in the next few years. The Robert Koch Institute's health monitoring makes an important contribution to checking the prognosis. Data on the prevalence of medically diagnosed diabetes mellitus, unrecognized diabetes and important diabetes risk factors are regularly collected in nationwide, population-representative health surveys.

Where does Germany stand in international comparison when it comes to diabetes?
In terms of the prevalence of doctor-diagnosed diabetes mellitus, Germany is currently in the top third in a European comparison and in the middle range worldwide. The overall highest prevalence of diabetes is observed in the Middle East, among the indigenous peoples of North America, in the populations of some South Sea island states and in India.

You are entrusted with leading a project to set up epidemiological diabetes surveillance. What exactly is the goal of the project?
Diabetes surveillance is intended to bring together the data already available in Germany in order to be able to make reliable and comparable statements about the disease and progress or remaining challenges in the prevention and care of diabetes mellitus in Germany.

What data, other than what has already been collected, is required for this?
Studies in nationwide health surveys conducted by the Robert Koch Institute not only provide prevalence estimates, but also allow an assessment of the spread of important diabetes risk factors, such as obesity and physical inactivity. However, they also have their limits. For example, examination surveys for which people have to come to a study center are not suitable for reliably estimating the number of people with serious diabetes-related complications in Germany or for comprehensively assessing the care provided for diabetes mellitus. In addition, no reliable assessments of the epidemiology and quality of care for type 1 diabetes or gestational diabetes are possible.

Couldn't you also include insured person data from the health insurance companies?
In fact, there is a wealth of routinely collected data, for example from statutory health insurance or DRG statistics. In addition, there is historical data on process and result quality from the disease management programs for type 1 and type 2 diabetes mellitus introduced in 2002-2004. To date, however, all of this data has only been used selectively for comprehensive and continuous diabetes reporting. It is planned to systematically include this data when setting up diabetes surveillance.

What are the challenges for the diabetes surveillance project?
As I said, the data is rich but fragmented. Firstly, we need a framework concept with suitable key figures for comprehensive and evidence-based health reporting on diabetes mellitus in order to inform the specialist public and advise health policy. And secondly, we need standards for bringing together relevant information to map these core indicators - they must be developed in close collaboration with the respective data holders and scientific cooperation partners at national and regional levels.

How do you specifically go about setting up surveillance?
The project duration is a total of four years, from August 2015 to July 2019, and is divided into:
development, an implementation and a product phase. First, a scientific framework concept should be agreed upon and published. This involves defining areas of action and core indicators as well as a final inventory of the basic usability of available data sources and the remaining data gaps.

What can be learned from diabetes surveillance for the detection of other chronic diseases?
It is very likely that adults with diabetes mellitus also have other chronic diseases. Data bases and indicators that are also relevant for other chronic diseases should therefore be used for diabetes surveillance. Experiences from other countries, such as Canada, have shown that diabetes mellitus is a good example that can be used to do pioneering work in establishing surveillance structures for non-communicable diseases. <<