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OBJECTIVE To compare patients' preferences in diabetes research to the current scientific research spectrum as presented during annual meetings of the European Association for the Study of Diabetes (EASD). METHODS After dividing all scientific activities in diabetes research into 9 main fields, a questionnaire was published in a popular German weekly news magazine, inviting diabetic patients to express their research preferences. Thereafter, all abstracts accepted for publication at 2 recent EASD meetings were allocated to one of these research fields. RESULTS In May and July 2011 the questionnaire was answered by 652 patients with diabetes, 205 relatives and 61 other persons interested. The most important research fields were "development, pathophysiology and prevention of diabetes" (25.6%), "transplantation and cell therapy" (19.4%) and "blood glucose measurement and artificial pancreas" (16.5%). The most often covered topic of the 2,645 EASD abstracts was "development, pathophysiology and prevention" (46.3%), followed by "diabetes complications in man" (17.5%) and "special situations, training, psychology, treatment- and care structures" (10.5%). CONCLUSION Views of diabetic patients and their relatives regarding their preferred research fields may differ when compared to current scientific activity in diabetology. Diabetic patients and their relatives should be involved in the weighting and selection of research topics more often.

Die Betreuung von Diabetespatienten, als Paradebeispiel fur die Betreuung chronisch Erkrankter, erfordert kooperative Strukturen im Versorgungssystem. Die Diabetologische Schwerpunktpraxis (DSP) ist ein wesentlicher Bestandteil dieses Systems. In einer Ubersicht wird die Bedeutung der DSP, ihr gegenwartiges und zukunftig zu erwartendes Arbeitsspektrum angesprochen. Es konnte in der Vergangenheit belegt werden, dass integrierte Versorgungssysteme nur durch adaquate Kooperation von Hausarzten und Diabetologen in DSP hinsichtlich ihrer Effektivitat zu verantwortbaren Ergebnissen fuhren. Der Erfolg integrierter Versorgungsprogramme, die konkrete Therapiezielfestlegungen sowie konkrete Uberweisungskriterien beinhalten, wird anhand des Outcomes von Evaluationsstudien belegt. Ein kunftiger Ubergang vom Disease-Management einzelner chronischer Erkrankungen hin zu einem effizienteren diagnoseubergreifenden „Chronic-Care-Management“ lasst eine weitere Intensivierung der Kooperation von Generalisten und Spezialisten erwarten. The management of diabetes patients, as a classic example for management of the chronically ill, requires cooperative structure in the health-care system. The Diabetology Specialist Practice (DSP) is an essential part of this system. The significance of the DSP, its current and expected future fields of activity are reviewed. In the past it has been demonstrated that integrated health-care systems can only lead to acceptable results with regard to efficacy through an adequate cooperation between general practitioners and diabetologist in DSPs. The success of integrated management programs that include the setting of concrete therapeutic targets as well as concrete referral criteria has been confirmed by the outcomes of evaluation studies. A future transition from disease management of individual chronic diseases to a more efficient diagnosis-independent chronic care management should lead to a further intensification of the cooperation between general practitioners and specialists.

Die Fachkommission Diabetes der Sachsischen Landesarztekammer (SLAK) hat mit der Herausgabe der 11. Auflage der Praxis-Leitlinie DIABETES mellitus Typ 2 eine Tradition fortgesetzt, das nationale und internationale Wissen in Therapieempfehlungen fur ambulant und stationar tatige Hausarzte und Diabetologen praxisnah zusammenzufassen. In der neuen Leitlinie wurden neue Studienergebnisse und deren Schlussfolgerungen sorgfaltig und kompetent eingearbeitet. Dabei wird insbesondere auf das Problem der anzustrebenden Stoffwechselqualitat fokussiert: dass es zur normnahen Stoffwechseleinstellung von Anfang an keine Alternative gibt, bei langerer Diabetesdauer risikoabhangige Therapieziele zu formulieren sind, in jedem Fall aber die Blutglukose-Selbstkontrolle notwendig ist, um Patienten vor schweren Hypoglykamien zu schutzen. Im Folgenden werden ausgewahlte Probleme angesprochen, die bei der Implementation der Leitlinien zu beachten sind. The medical specialists' commission for diabetology of the regional chamber of physicians in saxony has issued the 11th edition of the medical practice guidelines for type 2 diabetes mellitus. This continues a long-standing tradition of medical practice-oriented summaries of national and international knowledge of therapeutic recommendations for practising and hospital physicians and diabetologists. The new guidelines include detailed and competent interpretations of novel study results and their relevant conclusions. Emphasis is focussed on the problem of the on-target quality of metabolism and on the fact that there is from the very beginning no alternative to an adjustment to near-normal standards of metabolism and that risk-dependent therapeutic goals must be formulated if the diabetic condition continues to persist for a prolonged period while self-determination of blood glucose levels is always mandatory to protect the patient against severe hypoglycaemias. Selected problems are discussed in the following text which require attention while implementing the guidelines.

To date, data on the prevalence of diabetes mellitus in German hospitals have been insufficient. A several-years' study (Ludwigshafen-Limburg Diabetes Model Study) revealed definitely a prevalence of approximately 30 % as well as 75 % confirmed subsequent complications in all hospitalized patients. Hence, diabetes mellitus is one of the most frequent concomitant diseases of in-patients. Actually, however, the concomitant diagnosis ”diabetes mellitus” has so far been established in only 10 % of all in-patients and the subsequent complications have been recognized in only 10 % of these. Diabetic patients hospitalized as emergency cases for other reasons are definite safety risks that have so far hardly been recognized or systematically recorded as diabetics. Treatment quality can be improved by adequate structural and process management and the in-hospital period significantly reduced and cost saved. Adequate CCL-relevant coding can contribute to a considerable saving of cost. These structures can be effectively translated into reality only by means of qualified diabetology and super-departmentological competence without any departmentally defined restrictions. A structurally defined management of diabetes must be available for treating these patients. This management set-up must include inter alia an adequate training of the physicians and care personnel as well as algorithms for treatment in a variety of situations. This specific procedural catalog is being presented all over Germany in on-target multiprofessional management seminars (DEC seminars). Among others, specifically the German Hospitals Society and the cost-bearers are addressed to realize adequate structures.

In future, the profile of gastroenterology in Germany - as in other countries - will change. New achievements such as capsule endoscopy, aero-scopes and advanced CT and MRI technology and others will become alternatives to conventional endoscopy. Additional emphasis in clinical and outpatient gastroenterology is shifted towards gastrointestinal oncology, dietetics, nutrition and metabolism and in the clinical setting onto infectious diseases, endocrinology/diabetology, intensive care medicine, emergency service and geriatric medicine. The German Confederation of Gastroenterology (BVGD) initiated two Germany-wide surveys on the current diagnostic and therapeutic spectrum in hospitals and out-patient facilities to achieve a base for future discussions regarding the development of gastroenterology. The number of gastroenterologists working in hospitals and in out-patient facilities has been analysed as well as the number of examinations passed successfully during the last few years in the speciality "gastroenterology". The results of this survey offer a valid basis for continuing discussions as to how gastroenterology should develop in Germany.

BACKGROUND AND OBJECTIVES: Transferring adolescent patients with endocrine disorders from paediatric to adult care units depends on regional facilities with varying efficiency. A nationwide system of transition clinics in Germany is actually not available, despite demands by physicians and patients. PATIENTS AND METHODS: We conducted a survey for the 36 German university hospitals to examine the regional existence and characteristics of actual transition methods. In a second questionnaire patients were asked to report their individual transition periods. RESULTS: Despite physician's demand in the majority of hospitals, there are only eight transition clinics nationwide. On average 56 patients attended these clinics yearly. Most patients suffered from disorders of pituitary, thyroid or adrenal gland (each 76 %) and diabetes mellitus type 1 (82 %). The perception of teamwork between the paediatric and adult care units was better in hospitals with transition clinics. Moreover, there was more scientific cooperation in those hospitals. Attendance to medical care and patient's compliance was enhanced by establishing transition clinics in 82 % and 70 %, respectively. Questioning affected patients we found attendance to the paediatric team up to the age of twenty with substantial difficulties finding an adequate adult care unit. Patients were more contend with paediatric than adult quality of physicians care (mark 1.6 versus 2.4). 82 % of patients judged establishing transition clinics as "urgently needed". CONCLUSION: In conclusion there are transition clinics in one quarter of German university hospitals. A more widespread installation of transition clinics is medical reasonable and is demanded by patients.

Motivation Telemedical services for ophthalmology are developed within the OPHTEL project, which has been funded by the European Union and by the Bavarian government in the Bavaria-online initiative. Methods Seven private ophthalmologists, one university eye clinic, one clinical Diabetes center and an informatics research institute are connected within a teleconsultation network. Asynchronous (based on Internet E-Mail) and synchronous (based on ISDN-mediated videoconferencing tools) types of teleconsultations are realized. Results 86 teleconsultations (62 asynchronous, 23 synchronous) took place within the first 10 months. Complex and rare eye diseases as well as interdisciplinary questions (ophthalmology - diabetology) are the main area of medical communication interest. Legal and security problems are discussed. Conclusions Telemedical services must be understood as a complete process of medical care on the basis of modern communication technologies, which influences also the management of this process.