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Background: Post-viral symptoms have long been known in the medical community but have received more public attention during the COVID-19 pandemic. Many post-viral symptoms were reported as particularly frequent after SARS-CoV-2 infection. However, there is still a lack of evidence regarding the specificity, frequency and persistence of these symptoms in comparison to other viral infectious diseases such as influenza., Methods: We investigated a large population-based cohort based on German routine healthcare data. We matched 573,791 individuals with a PCR-test confirmed SARS-CoV-2 infection from the year 2020 to contemporary controls without SARS-CoV-2 infection and controls from the last influenza outbreak in 2018 and followed them up to 18 months., Results: We found that post-viral symptoms as defined for COVID-19 by the WHO as well as tissue damage were more frequent among the COVID-19 cohort than the influenza or contemporary control cohort. The persistence of post-viral symptoms was similar between COVID-19 and influenza., Conclusion: Post-viral symptoms following SARS-CoV-2 infection constitute a substantial disease burden as they are frequent and often persist for many months. As COVID-19 is becoming endemic, the disease must not be trivialized. Research should focus on the development of effective treatments for post-viral symptoms., (© 2024. The Author(s).)

Purpose: Evidence on the incidence and persistence of post-acute sequelae of COVID-19 (PASC) among children and adolescents is still limited., Methods: In this retrospective cohort study, 59,339 children and adolescents with laboratory-confirmed COVID-19 in 2020 and 170,940 matched controls were followed until 2021-09-30 using German routine healthcare data. Incidence rate differences (ΔIR) and ratios (IRR) of 96 potential PASC were estimated using Poisson regression. Analyses were stratified according to age (0-11, 12-17 years), and sex. At the individual level, persistence of diagnoses in patients with onset symptoms was tracked starting from the first quarter post-infection., Results: At 0-3 month follow-up, children and adolescents with a previous SARS-CoV-2 infection showed a 34% increased risk of adverse health outcome, and approximately 6% suffered from PASC in association with COVID-19. The attributable risk was higher among adolescents (≥ 12 years) than among children. For most common symptoms, IRRs largely persisted at 9-12 month follow-up. IRR were highest for rare conditions strongly associated with COVID-19, particularly inflammatory conditions among children 0-11 years, and chronic fatigue and respiratory insufficiency among adolescents. Tracking of diagnoses at the individual level revealed similar rates in the decline of symptoms among COVID-19 and control cohorts, generally leaving less than 10% of the patients with persistent diagnoses after 12 months., Conclusion: Although very few patients presented symptoms for longer than 12 months, excess morbidity among children and, particularly, adolescents with a history of COVID-19 means a relevant burden for pediatric care., (© 2024. The Author(s).)

Background: Surveillance of diabetes requires up-to-date information on the prevalence of diabetes and its complications over time. For this purpose, statutory health insurance (SHI) data is being increasingly used, as the data is available in a timely fashion and case numbers enable detailed estimates also of diabetes complications. The aim of the present study was the development and internal validation of case definitions for the prevalence estimation of diabetic retinopathy (DRP), diabetic polyneuropathy (DPN) and diabetic foot syndrome (DFS)., Methods: Persons with diabetes differentiated by type 1, type 2, and other diabetes in an age- and sex-stratified sample of persons insured by Barmer SHI in 2018 (n=72,744) comprised the study popuation. Based on the central ICD codes for microvascular complications (DRP: H36.0; DPN: G63.2; DFS: E1X.74/.75), case definitions were developed including additional ICD codes for complications without direct diabetes reference. Subsequently, the case definitions were internally validated. For the validation, coding in the inpatient setting (m1S) or repeatedly in the outpatient setting (m2Q) as well as coding of specific procedures (EBM, OPS) and drug prescriptions or by relevant specialists were considered. Additionally, we analysed the documentation of the diagnoses in the previous years., Results: In 2018, the prevalence of the central ICD codes was 8.4% for DRP (H36.0), 18.9% for DPN (G63.2) and 13.4% for DFS (E1X.74/.75). After inclusion of additional ICD codes in the case definition, prevalence increased significantly for DRP (9.6%) and DPN (20.7%), and barely for DFS (13.5%). Internal validation confirmed the majority of diagnoses (DRP: 96.7%; DPN: 96.5% DFS: 95.8%) and m2Q represented the most relevant criterion. When up to four previous years were considered, prevalences were up to 30% higher for DPN and DFS and up to 64% higher for DRP., Conclusion: The inclusion of additional ICD codes in the case definition of microvascular complications of diabetes appears meaningful, as this increases the sensitivity of the prevalence estimate. Internal validation suggests that the documented diagnoses are plausible. However, not all diagnoses are documented annually, leading to an underestimation of the prevalence using a cross-sectional study design of one year., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Evaluations by the statutory health insurance carriers in Germany have revealed a rising prevalence of diagnoses of mental disorders, at varying levels and to varying extents. For mental health surveillance purposes, we analyzed prevalence trends across health insurance carriers, before and during the COVID-19 pandemic and stratified by diagnosis group, sex and age., Methods: Nationwide outpatient claims data of all statutorily insured individuals for the years 2012-2022 (Nmin = 68.7 million people, Nmax = 73.7 million people) were used to determine the diagnostic prevalence of mental disorders (ICD-10 F00-F99 and five selected diagnosis groups), with stratification by sex and age. Changes over time in the spectrum of all documented mental disorders are described., Results: Over the period 2012-2022, the percentage of people with outpatient diagnoses of mental disorders rose from 33.4% to 37.9% (a relative increase of 13.4%). In the selected diagnosis groups, the trends ranged from -11.6% to +115.8% and were generally steady over time, though stronger or stagnating trends were seen in some groups from 2020 onward. Diagnostic prevalence rose to a greater extent in male (+18.3%) than in female individuals (+10.8%) over the period 2012-2022. The greatest increases (> +15%) were seen among 11- to 17-yearolds and in 60- to 84-year-olds. The composition of the diagnosis spectrum was more stable in adults than in children and adolescents., Conclusion: Trends in diagnostic prevalence differ across mental disorders and population subgroups and have changed in some diagnosis groups since the COVID-19 pandemic. Contextualizing research is needed for a better understanding of these developments.

Background: Gestational diabetes mellitus (GDM) increases the risk for adverse pregnancy outcomes. In 2012, a general screening for GDM was introduced in Germany., Methods: The analysis is based on data from the external inpatient quality assurance for obstetrics from the years 2013 to 2021. Women with pregestational diabetes were excluded. GDM was defined either by documentation in the maternity record or by ICD diagnosis O24.4 during hospitalisation. We reported the prevalence stratified by year, maternal age and regional socioeconomic deprivation., Results: The age-standardized prevalence of GDM continuously rose from 4.7 % in 2013 to 8.5 % in 2021. The increase was observed in all age groups. In 2021, this corresponded to 63,563 women with GDM. The prevalence was higher in highly deprived regions than in low deprived regions., Conclusion: A steady increase in GDM prevalence and evidence of health inequalities emphasise the need for primary prevention strategies for GDM., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Background: Diabetes-related amputations reduce health-related quality of life and are an indicator of the quality of care of diabetes., Methods: Population-based age-standardized rates for diabetes-related cases of major and minor amputation were calculated and reported for the years 2015 - 2022 using the Diagnosis-related groups statistics. For 2022 these rates were also reported according to area-level socioeconomic deprivation., Results: Diabetes-related major amputations decreased from 6.8 to 5.2 per 100,000 residents in women and from 18.6 to 17.5 per 100,000 residents in men between 2015 and 2022. In 2021 and 2022, there was no further decrease in men compared to the previous year. Diabetes-related minor amputations decreased in women between 2015 and 2022, but increased in men. Amputation rates were higher in regions with high deprivation than in regions with low deprivation., Conclusions: Diabetes care should consider socioeconomic differences into account. The monitoring of the trends in amputations needs to be continued., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

The routine data of all statutorily insured persons according to the Data Transparency Regulation (DaTraV data) represent a promising data source for the recurrent and timely surveillance of non-communicable diseases (NCDs) in Germany. Thereby, it has become apparent that there is a high demand for reference evaluations that enable quick and regularly repeatable analyses on important NCDs. Against this background, ReFern-01 was initiated, a joint project of the Robert Koch Institute (RKI) and the Federal Institute for Drugs and Medical Devices (BfArM). In collaboration with experts from the field of secondary data analysis and healthcare research, reference evaluations for estimating prevalence, incidence, and mortality for important public health-relevant diseases were developed. First, 11 central NCDs were selected by means of an online survey, and initial case definitions were created in conjunction with a literature review. These were then discussed and agreed upon in a virtual workshop. The created reference evaluations (analysis scripts) allow a standardized estimation of the mentioned epidemiological figures, which are comparable over time and regionally. In addition to providing the results, the scripts will be available at the BfArM for further analysis. Provided that remote access to the analysis of the DaTraV data is available in the future, the results of the ReFern project can strengthen the surveillance of NCDs and support public health actors, for example, in the planning and implementation of health promotion and prevention measures at the federal, state, county, and local levels., (© 2024. The Author(s).)

Background: To date, there is no data available depicting the trend of the incidence of type 1 and type 2 diabetes across all age groups for the COVID-19 pandemic years in Germany., Methods: Based on anonymized routine data from nine million persons covered by statutory health insurance, newly diagnosed diabetes cases (ICD diagnosis E10.- to E14.-) in inpatient or (confirmed in two quarters) outpatient setting were estimated for 2015 to 2021, differentiating between type 1 and type 2 diabetes. The data were linked to the German Index of Socioeconomic Deprivation. The results are age-standardised (population as of 31 Dec. 2021)., Results: Between 2015 and 2021, the incidence of type 1 diabetes increased from 9.5 to 11.6 per 100,000 persons (from 7,007 to 8,699 new cases per year). In contrast, the incidence of type 2 diabetes tended to decline between 2015 and 2019. It continued to drop initially in 2020 during the pandemic, and then rose to 740 per 100,000 persons in 2021 (556,318 new cases per year). The diabetes type-specific seasonal pattern of previous years has changed during the pandemic years. The incidence of both type 1 and type 2 diabetes was observed to be higher in regions of high socioeconomic deprivation as compared to regions characterised by low socioeconomic deprivation., Conclusions: The increase in the incidence of type 1 and type 2 diabetes in 2021 may possibly be related to the COVID-19 pandemic. The high incidence and the differences by regional socioeconomic deprivation indicate that there is a need for targeted prevention strategies., Competing Interests: Conflicts of interest The authors declare that there is no conflict of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Objectives: To investigate whether the risk of developing an incident autoimmune disease is increased in patients with prior COVID-19 disease compared to those without COVID-19, a large cohort study was conducted., Method: A cohort was selected from German routine health care data. Based on documented diagnoses, we identified individuals with polymerase chain reaction (PCR)-confirmed COVID-19 through December 31, 2020. Patients were matched 1:3 to control patients without COVID-19. Both groups were followed up until June 30, 2021. We used the four quarters preceding the index date until the end of follow-up to analyze the onset of autoimmune diseases during the post-acute period. Incidence rates (IR) per 1000 person-years were calculated for each outcome and patient group. Poisson models were deployed to estimate the incidence rate ratios (IRRs) of developing an autoimmune disease conditional on a preceding diagnosis of COVID-19., Results: In total, 641,704 patients with COVID-19 were included. Comparing the incidence rates in the COVID-19 (IR=15.05, 95% CI: 14.69-15.42) and matched control groups (IR=10.55, 95% CI: 10.25-10.86), we found a 42.63% higher likelihood of acquiring autoimmunity for patients who had suffered from COVID-19. This estimate was similar for common autoimmune diseases, such as Hashimoto thyroiditis, rheumatoid arthritis, or Sjögren syndrome. The highest IRR was observed for autoimmune diseases of the vasculitis group. Patients with a more severe course of COVID-19 were at a greater risk for incident autoimmune disease., Conclusions: SARS-CoV-2 infection is associated with an increased risk of developing new-onset autoimmune diseases after the acute phase of infection. Key Points • In the 3 to 15 months after acute infection, patients who had suffered from COVID-19 had a 43% (95% CI: 37-48%) higher likelihood of developing a first-onset autoimmune disease, meaning an absolute increase in incidence of 4.50 per 1000 person-years over the control group. • COVID-19 showed the strongest association with vascular autoimmune diseases., (© 2023. International League of Associations for Rheumatology (ILAR).)

Background: Trends over time and possible socio-spatial inequalities in the incidence and care of type 1 diabetes mellitus (T1D) in children and adolescents are important parameters for the planning of target-specific treatment structures., Methodology: The incidence and prevalence of type 1 diabetes, diabetic ketoacidosis and severe hypoglycaemia as well as the HbA1c value are presented for under 18-year-olds based on data from the nationwide Diabetes Prospective Follow-up Registry (DPV) and the diabetes registry of North Rhine-Westphalia. Indicators were mapped by sex over time between 2014 and 2020, and stratified by sex, age and regional socioeconomic deprivation for 2020., Results: In 2020, the incidence was 29.2 per 100,000 person-years and the prevalence was 235.5 per 100,000 persons, with the figures being higher in boys than in girls in either case. The median HbA1c value was 7.5%. Ketoacidosis manifested in 3.4% of treated children and adolescents, significantly more often in regions with very high (4.5%) deprivation than in regions with very low deprivation (2.4%). The proportion of severe hypoglycaemia cases was 3.0%. Between 2014 and 2020, the incidence, prevalence and HbA1c levels changed little, while the proportions of ketoacidosis and severe hypoglycaemia decreased., Conclusions: The decrease in acute complications indicates that type 1 diabetes care has improved. Similar to previous studies, the results suggest an inequality in care by regional socioeconomic situation., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Background: Diabetes mellitus is a disease of high public health relevance. To estimate the temporal development of prevalence, routine data of statutory health insurances (SHI) are being increasingly used. However, these data are primarily collected for billing purposes and the case definition of specific diseases remains challenging. In this study, we present an algorithm for differentiation of diabetes types analyzing SHI routine data., Methods: The basis for the analysis was an age and sex-stratified random sample of persons of the Barmer SHI with a continuous insurance duration from 2010 to 2018 in the magnitude of 1% of the German population. Diabetes was defined in the reporting year 2018, as documentation of (1) a "confirmed" ICD diagnosis E10.- to E14.- in at least two quarters, (2) a "confirmed" ICD diagnosis E10.- to E14.- in one quarter with an additional prescription of an antidiabetic drug (ATC codes A10), or (3) an ICD diagnosis E10.- to E14.- in the inpatient sector, outpatient surgery, or work disability. Individuals were assigned to a diabetes type based on the specific ICD diagnosis E10.- to E14.- and prescribed medications, differentiated by insulin and other antidiabetics. Still unclear or conflicting constellations were assigned on the basis of the persons' age or the frequency and observation of the diagnosis documentation over more than one year. The participation in a disease management program was considered in a sensitivity analysis., Results: The prevalence of documented diabetes in the Barmer sample was 8.8% in 2018. Applying the algorithm, 98.5% of individuals with diabetes could be classified as having type 1 diabetes (5.5%), type 2 diabetes (92.6%), or another specific form of diabetes (0.43%). Thus, the prevalence was 0.48% for type 1 diabetes and 8.1% for type 2 diabetes in 2018., Conclusion: The vast majority of people with diabetes can be classified by their diabetes type on the basis of just a few characteristics, such as diagnoses, drug prescription, and age. Further studies should assess the external validity by comparing the results with primary data. The algorithm enables the analysis of important epidemiological indicators and the frequency of comorbidities based on routine data differentiated by type 1 and type 2 diabetes, which should be considered in the surveillance of diabetes in the future., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Diabetes mellitus (DM) is a major risk factor for complications of pregnancy. Based on information for all inpatient births in Germany, we assessed the risks for selected pregnancy complications in women with pregestational diabetes mellitus (preDM) or gestational diabetes mellitus (GDM)., Methods: The underlying data comprised all singleton births contained in the inpatient perinatal medicine quality assurance statistics for the years 2013-2019. The frequencies of premature birth, elevated birth weight (large for gestational age, LGA), cesarean section, transfer of the newborn to the perinatal unit, and stillbirth were stratified by maternal age and diabetes status (preDM, GDM, no DM). Poisson regression was used to calculate the relative risks (RR) with 95% confidence intervals (95% CI) for the whole period and for each individual year in women with preDM or GDM relative to women without DM., Results: Among the 4 991 275 singleton births included, GDM was documented in 283 210 (5.7%) and preDM in 46 605 (0.93%) cases. GDM was associated with higher RR for premature birth (1.13 [1.12; 1.15]), LGA (1.57 [1.55; 1.58]), cesarean section (1.26 [1.25; 1.27]), and transfer of the newborn (1.54 [1.52; 1.55]). These associations were even stronger in women with preDM: premature birth (2.13 [2.08; 2.18]), LGA (2.72 [2.67; 2.77]), cesarean section (1.62 [1.60; 1.64]), transfer of the newborn (2.61 [2.56; 2.66]). PreDM increased the risk of stillbirth (RR: 2.34 [2.11; 2.59]); GDM was associated with a lower risk (RR: 0.67 [0.62; 0.72]). For women with preDM, the risk of pregnancy complications increased over the study period., Conclusion: GDM and preDM are still associated with elevated risks of pregnancy complications. In the case of preDM, the risks may be attributable to the fact that the hyperglycemia is more severe and is already present before conception. Continuous monitoring should include risk factors in pregnant women and care-relevant aspects.

Background: .Summary measures such as disability-adjusted life years (DALY) are becoming increasingly important for the standardized assessment of the burden of disease due to death and disability. The BURDEN 2020 pilot project was designed as an independent burden-of-disease study for Germany, which was based on nationwide data, but which also yielded regional estimates., Methods: DALY is defined as the sum of years of life lost due to death (YLL) and years lived with disability (YLD). YLL is the difference between the age at death due to disease and the remaining life expectancy at this age, while YLD quantifies the number of years individuals have spent with health impairments. Data are derived mainly from causes of death statistics, population health surveys, and claims data from health insurers., Results: In 2017, there were approximately 12 million DALY in Germany, or 14 584 DALY per 100 000 inhabitants. Conditions which caused the greatest number of DALY were coronary heart disease (2321 DALY), low back pain (1735 DALY), and lung cancer (1197 DALY). Headache and dementia accounted for a greater disease burden in women than in men, while lung cancer and alcohol use disorders accounted for a greater disease burden in men than in women. Pain disorders and alcohol use disorders were the leading causes of DALY among young adults of both sexes. The disease burden rose with age for some diseases, including cardiovascular diseases, dementia, and diabetes mellitus. For some diseases and conditions, the disease burden varied by geographical region., Conclusion: The results indicate a need for age- and sex-specific prevention and for differing interventions according to geographic region. Burden of disease studies yield comprehensive population health surveillance data and are a useful aid to decision-making in health policy.

Based on data from the CORONA-MONITORING lokal (CoMoLo) study conducted in four municipalities particularly affected by the COVID-19 pandemic, this article investigates the non-utilisation of health care services in the population aged 18 years and older (n=9,002) in relation to the period after the introduction of the containment measures in March 2020. The results show that about one third of the respondents (35.5%) gave up at least one of the surveyed health care services. The most frequent cancellations were dental (15.2%) and specialist check-ups (11.8%), followed by postponement of physiotherapy, ergotherapy or speech therapy (6.1%), cancellation of general practitioner (GP) check-ups (5.8%), postponement of psychotherapy (2.0%), postponement of planned hospital treatment (1.8%) and not going to an emergency room (0.7%). Almost 10% of the respondents reported not visiting a physician despite health complaints. Compared to respondents without such a waiver, these respondents were more often female and younger than 35 years, less often rated their health as very good or good, more often had a diagnosis of depression and more often used telemedical contacts as an alternative to visiting the practice during the pandemic. Further analyses of trends in utilisation behaviour and changes in health status over the course of the COVID-19 pandemic are important., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

During the COVID-19 pandemic in Germany, non-pharmaceutical interventions were imposed to contain the spread of the virus. Based on cross-sectional waves in March, July and December 2020 of the COVID-19 Snapshot Monitoring (COSMO), the present study investigated the impact of the introduced measures on the perceived access to health care. Additionally, for the wave in December, treatment occasion as well as utilization and satisfaction regarding telemedicine were analysed. For 18-74-year-old participants requiring medical care, descriptive and logistic regression analyses were performed. During the less strict second lockdown in December, participants reported more frequently ensured access to health care (91.2%) compared to the first lockdown in March (86.8%), but less frequently compared to July (94.2%) during a period with only mild restrictions. In December, main treatment occasions of required medical appointments were check-up visits at the general practitioner (55.2%) and dentist (36.2%), followed by acute treatments at the general practitioner (25.6%) and dentist (19.0%), treatments at the physio-, ergo- or speech therapist (13.1%), psychotherapist (11.9%), and scheduled hospital admissions or surgeries (10.0%). Of the participants, 20.0% indicated utilization of telemedical (15.4% telephone, 7.6% video) consultations. Of them, 43.7% were satisfied with the service. In conclusion, for the majority of participants, access to medical care was ensured during the COVID-19 pandemic; however, access slightly decreased during phases of lockdown. Telemedicine complemented the access to medical appointments.

As a condition, diabetes mellitus is associated with risk factors and diseases such as obesity. At the same time, cardiovascular diseases are a frequent consequence of diabetes. There have yet to be any findings on the Germany-wide prevalence of diabetes and diabetes comorbidities based on statutory health insurance data. This study estimates the documented prevalence of diabetes in 2019 on the basis of all ambulatory physicians' claims data of German statutory health insurance. In addition, the prevalence of obesity, high blood pressure, coronary heart disease, heart failure, stroke and depression is calculated for diabetes and non-diabetes patients, and the prevalence ratio (PR) is determined as a quotient. The approach used was a case-control design, which assigns a control person without diabetes to each diabetes patient who is similar in terms of age, region and sex. In diabetes patients, a PR greater than 1 was observed for all examined diseases across all age groups, thus demonstrating a higher prevalence compared to persons without diabetes. The highest PR across all age groups for women (3.8) and men (3.7) was found for obesity. In a comparison over time, documented prevalence figures of diabetes in Germany stagnate. With the exception of depression, the documented prevalences of comorbidities correspond well with the prevalences found in population-wide examination surveys., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Gestational diabetes mellitus (GDM) is an important risk factor for pregnancy complications. Since 2012, the Federal Joint Committee's maternity directive recommends a two-step screening for GDM with a pre-test and subsequent diagnostic test if the pre-test is positive. This study analyses the implementation and development over time of GDM screening participation and prevalence in Germany. The data basis is the external inpatient obstetrics quality assurance documentation, which covers all births in hospital. Women with diabetes before pregnancy were excluded. The study defined women as GDM cases if the condition was documented in maternity records or if the ICD-10 diagnosis O24.4 was coded for inpatients at discharge and figures were determined for the years 2013 to 2018. As the documentation of screening tests has only been included in the data set since 2016, screening participation for the years 2016 to 2018 were estimated and evaluated based on the pre-test and/or diagnostic tests documented in maternity records. In 2018, the majority of all women who gave birth in hospitals had had a pre-test conducted (65.0%) or a pre-test and diagnostic test (18.2%) in line with the two-step procedure. A further 6.7% received a diagnostic test alone. GDM screening participation increased over time from 83.4% in 2016 to 89.9% in 2018. The prevalence of a documented GDM increased from 4.6% to 6.8% between 2013 and 2018. In 2018, this equates to 51,318 women with GDM. Reliably assessing the extent and causes of this development will require continuous analyses of screening implementation, documentation and changes in maternal risk factors., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

In addition to life expectancy, the length of time a person can expect to remain free of health-related functional impairments is becoming increasingly important both for the individuals concerned and for society at large. The indicator healthy life years used for this purpose is a key figure for mapping mortality and morbidity. Diabetes is one of the most common chronic diseases and can be associated with health-related functional impairments. In 2014, women and men with diabetes could expect to have significantly fewer healthy life years than people without diabetes; this particularly applies to younger and middle-aged groups. Among 30- to 34-year-olds, for example, women and men with diabetes could expect eleven and twelve fewer healthy life years respectively than people without diabetes. These differences narrow with increasing age. Ensuring that people with and without diabetes have a similar length of lifetime free of health impairments is an important task for public health., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Background: Data sources for the systematic and ongoing analysis of prevalence of microvascular complications of diabetes mellitus are limited in Germany. For the first time, we estimated the complications prevalence based on claims data of all statutory health insurance (SHI) providers according to the Data Transparency Act., Methods: Health claims data of the reporting years 2012 and 2013 were analyzed. The reference population was identified as insured persons with a diabetes diagnosis according to the international classification of disease. Diabetes was defined as documentation of at least two confirmed diabetes diagnoses in an outpatient setting or one diagnosis in an inpatient setting (ICD codes E10-E14). Complications were defined based on the following ICD codes: nephropathy (N08.3), retinopathy (H36.0), polyneuropathy (G63.2), diabetic foot syndrome (DFS; E10-14.74, E10-14.75), chronic kidney disease (N18.-), and treatment with dialysis (Z49.1, Z49.2, Z99.2). Results were compared to prevalence estimates based on routine data and registries in Germany and abroad., Results: In 2013, diabetes was documented for 6.6 million persons with SHI (2012: 6.5 million). In 2013, chronic kidney disease (15.0%) was the most frequent complication, followed by diabetic polyneuropathy (13.5%), nephropathy (7.6%), retinopathy (7.0%), DFS (6.1%), and treatment with dialysis (0.56%). While results for diabetic retinopathy, nephropathy, and polyneuropathy are lower than prevalence estimates from other type 2 diabetes studies, they are comparable for chronic kidney disease, treatment with dialysis, and DFS., Conclusion: Continuous analysis of health claims data is highly valuable for the diabetes surveillance. However, detailed analyses are required for verification and harmonization of case definitions and documentation practice.

Health reporting as an integral part of public health plays an important role in the development of strategies and concepts that aim to improve the health of all population groups. This article provides an overview of the definition and tasks of federal health reporting and describes important health reporting components in their current form. The publication format of the Journal of Health Monitoring, which was developed for different user groups of health monitoring, is presented. Examples of the uses and effects of health reporting are also presented. Health reporting is designed as a flexible system: changes in databases as well as forms of communication are taken into account in the further development of health reporting.The further development of health reporting requires close interdisciplinary cooperation between different actors in order to integrate current research results from various scientific disciplines into the processes of health reporting, as well as to further expand the scope and impact of health reporting. In addition, to further develop health reporting on a scientific level, the expansion of participatory elements and a stronger internationalization will be important future tasks.

The continuous collection and analysis of health data on relevant diseases (surveillance) is at the core of public health. The surveillance enables the implementation of measures to protect the populations' health. Therefore, relevant information needs to be provided in a timely and target-group-specific manner to the respective stakeholders.A dissemination strategy supports the effective communication of results and considers three key questions: (1) "What content is relevant to the surveillance?", (2) "Who requires which information?" and (3) "How are the results disseminated to the target audience?" In this context, digitalisation allows for novel possibilities in the design of publication formats.Since 2015, diabetes surveillance has been established at the Robert Koch Institute. Within a structured process of consensus, we defined four fields of action relevant for health policy including 40 indicators. Thereafter, we developed the first publication formats in collaboration with the scientific advisory board of the project that reflected novel possibilities offered by digitalisation. In addition to articles in scientific journals, the essential formats of the first project phase comprise the report "Diabetes in Germany" and a website including interactive visualisations of results. Additional posts on Twitter and YouTube are used to increase coverage.In addition to the further development of the indicator set, the focus of the next project phase is the advancement of the dissemination towards user- and action-oriented reporting. In close exchange with the scientific advisory board, we aim to explore the requirements of the target audience and reflect them in the design of further publication formats.

Background: The prevalence and incidence of documented diabetes are two essential indicators intended to be reported on a periodic basis within the framework of diabetes surveillance in Germany., Methodology: Data provided based on the Data Transparency Act were analyzed. The data contain information on outpatient and inpatient care for all approximately 70 million persons with statutory health insurance. The case definition for the prevalence of documented diabetes comprises a confirmed outpatient diagnosis in at least two quarters of a year or an inpatient diagnosis in at least one quarter of a year in accordance with ICD-10 codes E10.- to E14.-. The incidence was calculated based on the same definition and with one year of diagnosis-free lead time., Results: In 2011, a prevalence of 9.7% (women: 9.4%, men: 10.1%) was observed for persons with statutory health insurance. There are considerable differences in prevalence between the federal states and the maximum gap is 7.1 percentage points (age standardized: 4.0 percentage points). Type 2 and type 1 diabetes show a documented prevalence of 7.5% and 0.28%, respectively. Unspecified diabetes is documented relatively frequently with 1.9%. In 0.21% of persons, the diagnosis diabetes is documented via one inpatient secondary diagnosis. In addition, 0.17% of people without documented diabetes have at least one prescription of an antidiabetic drug. In 2012, 565,040 insured persons were newly diagnosed with diabetes; this corresponds to 1.0% of the insured persons (women: 1.0%, men: 1.1%)., Discussion: The developed reference analysis is suitable for reporting the prevalence and incidence of documented diabetes within the framework of diabetes surveillance. The differentiation of diabetes types is difficult due to coding practice.

In addition to the Robert Koch Institute's health surveys, analyses of secondary data are essential to successfully developing a regular and comprehensive description of the progression of diabetes as part of the Robert Koch Institute's diabetes surveillance. Mainly, this is due to the large sample size and the fact that secondary data are routinely collected, which allows for highly stratified analyses in short time intervals. The fragmented availability of data means that various sources of secondary data are required in order to provide data for the indicators in the four fields of action for diabetes surveillance. Thus, a milestone in the project was to check the suitability of different data sources for their usability and to carry out analyses. Against this backdrop, co-operation projects were specifically funded in the context of diabetes surveillance. This article presents the results that were achieved in co-operation projects between 2016 and 2018 that focused on a range of topics: from evaluating the usability of secondary data to statistically modelling the development of epidemiological indices. Moreover, based on the data of the around 70 million people covered by statutory health insurance, an initial estimate was calculated for the documented prevalence of type 2 diabetes for the years 2010 and 2011. To comparably integrate these prevalences over the years in diabetes surveillance, a reference definition was established with external expertise., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Against the background of the growing burden associated with diabetes mellitus, the German Federal Ministry of Health commissioned the Robert Koch Institute to develop a national diabetes surveillance. The periodic publication of up-to-date data needed by diverse target audiences (dissemination) to develop subsequent public health measures is a crucial aspect of disease surveillance. The study produced an overview of diabetes surveillance in various countries with the intention of developing a dissemination strategy. This involved a two-stage process beginning with an online survey of public health experts from 46 countries. Structured Internet research was then carried out for countries that did not provide a response (19 out of 46). The majority of countries (38 out of 46; 83%) include diabetes in their health reporting; three quarters (29 out of 38; 77%) of these countries rely on an indicator-based reporting system. The study found that the most common formats used to publish information about diabetes and other noncommunicable diseases were topic-specific reports (24 out of 36; 67%) and national health reports (23 out of 36; 64%), followed by online formats such as websites or databases (20 out of 36; 57%). Moreover, health reporting primarily targets politicians (19 out of 20; 95%) as well as the media and the press (16 out of 20; 80%). The study found that both printed and online publications form part of a comprehensive dissemination strategy, however address different audiences., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Diabetes mellitus and other noncommunicable diseases (NCDs) represent an emerging global public health challenge. In Germany, about 6.7 million adults are affected by diabetes according to national health surveys, including 1.3 million with undiagnosed diabetes. Complications of diabetes result in an increasing burden for individuals and society as well as enormous costs for the health care system. In response, the Federal Ministry of Health commissioned the Robert Koch Institute (RKI) to implement a diabetes surveillance system and the Federal Center for Health Education (BZgA) to develop a diabetes prevention strategy. In a two-day workshop jointly organized by the RKI and the BZgA, representatives from public health institutes in seven countries shared their expertise and knowledge on diabetes prevention and surveillance. Day one focused on NCD surveillance systems and emphasized both the strengthening of sustainable data sources and the timely and targeted dissemination of results using innovative formats. The second day focused on diabetes prevention strategies and highlighted the importance of involving all relevant stakeholders in the development process to facilitate its acceptance and implementation. Furthermore, the effective translation of prevention measures into real-world settings requires data from surveillance systems to identify high-risk groups and evaluate the effect of measures at the population level based on analyses of time trends in risk factors and disease outcomes. Overall, the workshop highlighted the close link between diabetes prevention strategies and surveillance systems. It was generally stated that only robust data enables effective prevention measures to encounter the increasing burden from diabetes and other NCDs.

Objectives: Mevalonate kinase deficiency, a rare autosomal recessive autoinflammatory disease, is caused by mutations in the MVK gene encoding mevalonate kinase (MK). MK catalyzes the phosphorylation of mevalonic acid to mevalonate-5-phosphate (MVAP) in the pathway of isoprenoid and sterol synthesis. The disease phenotype correlates with residual activity ranging from <0.5% for mevalonic aciduria to 1-7% for the milder hyperimmunoglobulinemia D and periodic fever syndrome (HIDS). Hence, assessment of loss-of-function requires high accuracy measurements. We describe a method using isotope dilution UPLC-MS/MS for precise and sensitive determination of MK activity., Design and Methods: Wild-type MK and the variant V261A, which is associated with HIDS, were recombinantly expressed in Escherichia coli. Enzyme activity was determined by formation of MVAP over time quantified by isotope dilution UPLC-MS/MS. The method was validated according to the FDA Guidance for Bioanalytical Method Validation., Results: Sensitivity for detection of MAVP by UPLC-MS/MS was improved by derivatization with butanol-HCl (LLOQ, 5.0 fmol) and the method was linear from 0.5 to 250 μmol/L (R(2) > 0.99) with a precision of ≥ 89% and an accuracy of ± 2.7%. The imprecision of the activity assay, including the enzymatic reaction and the UPLC-MS/MS quantification, was 8.3%. The variant V261A showed a significantly decreased activity of 53.1%., Conclusion: Accurate determination of MK activity was enabled by sensitive and reproducible detection of MVAP using UPLC-MS/MS. The novel method may improve molecular characterization of MVK mutations, provide robust genotype-phenotype correlations, and accelerate compound screening for drug candidates restoring variant MK activity., (Copyright © 2015 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.)