Diabetes guidelines with two paths to the target corridor

06.03.2013 17:26

The next National Care Guideline (NVL) for the indication diabetes is now available. It will probably be shared by all specialist societies, but there will be two different therapeutic paths.

“If you try to come to an agreement over many years, but then it turns out that you cannot agree, you have to present the paths favored by the various professional societies - here are two - for reasons of transparency.” That’s what Prof. Dr. says med. Stephan Matthaei, President of the German Diabetes Society (DDG), in an interview that the trade journal Market Access & Health Policy (MA&HP 02/2013) conducted with him about the current decisions of the G-BA and which will be published next Monday. Enough time has passed since the first edition of the NVL for type 2 diabetes was published (already) in 2002 and the first modules of the NVL type 2 diabetes were published in the second edition in 2006.

There seems to be a consensus in turning away from the previously rather Clucocentric worldview. after the European (EASD) and the US Diabetes Association (ADA) almost a year ago, on April 19, 2012, together a new guideline for the treatment of type 2 diabetes significantly less precise regulations and recommendations on therapy goals and medications in the form of algorithms The upcoming German NVL Diabetes also appears to have been published to focus more on the individual patient. What amounts to a farewell to the Clucocentric world view, in which the Target value of HbA1c – for Example with 6.5 - or the blood pressure was rigidly defined. In the future should There are individual target corridors for each individual patient: An older person with Cardiovascular diseases and long Existing diabetes is therefore reduced must be strictly controlled as a young diabetes patient.

That was the good news. The bad thing is that DDG and DEGAM, despite many discussions apparently could not agree on a single best way to achieve these target corridors. There will be differences primarily in the type of blood sugar measurement as well as in the medication, although the latter will only be indicated when if the non-pharmacological therapy as ineffective proves:An is still the first priority Metformin. But then?

Some still favor sulfonylureas, others the much more modern DDP 4 inhibitors, which bring benefits especially to younger diabetes patients, although endpoint-driven studies are still missing. And at least as long as it is still exists in Germany, as Matthaei warns: Based on the current G-BA decision against linagliptin (see MA&HP 2/2013) and Based on similar study evidence in the existing market for all gliptins, he assumes that the respective IQWiG reports for the Expected on July 1st of this year, this also has no additional benefit will attest. Matthaei: “Because of this Reports suggest that the G-BA ended in the third quarter of 2013 the entire class of substances will be decided.”