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Ben RHM II - LZG.NRW

Ben RHM II - LZG.NRW

Benchmarking Regional Health Management II (Ben RHM II) ___________________________________________________________________________________________________________________________________________________________________ check-up are screened for diabetes every three years. Moravia-Silesia (CZ), on the other hand, screens patients without risk factors every two years. Patients in Moravia-Silesia (CZ) and in Chuvash Republic (RU) with a higher risk of falling ill due to risk factors are screened every year. Illus. 21: Examination interval for the detection (screening) of diabetes (type II) Every 3 years Every 2 years Every year without details BMI ≥ 27 and < 35 years women with "big baby" last check-up with 'normal' results < 40 years without risk factors > 45 years > 40 years > 35 years every insured patient with higher risk factors 1 < 35 years; 2 < 35 years > 40 years - 282 - HU-G DE-NRW DE-NRW 1 DE-NRW 2 , EL AT CZ IT-E AT, HU-S DE-NRW, DE-ST BG CZ, RU CZ, RU 0 1 2 3 number of regions There are no restrictions for diabetes screening in Varna-Oblast in Bulgaria; here every patient can have diabetes screening once a year. 6.3.1.6 Detection examination of pregnant women Gestational diabetes is a disease which is increasing worldwide and one of the most frequent complications during pregnancy. (Linn/Lang 2006: 196) Gestational diabetes is defined as hyperglycaemia which is first recognised during pregnancy. Symptoms of gestational diabetes are similar to type II diabetes. Gestational diabetes is most often diagnosed through prenatal screening, rather than reported symptoms. 111 In Germany, the expected frequency of gesta- tional diabetes is up to 6% of all pregnancies. This corresponds to almost 50.000 cases per 111 http://www.who.int/mediacentre/factsheets/fs312/en/index.html (21.06.2007).

Benchmarking Regional Health Management II (Ben RHM II) ___________________________________________________________________________________________________________________________________________________________________ year. Diagnosing this disease is important since it is related to increased morbidity of mother and child. Gestational diabetes usually goes away after pregnancy. But once women have had gestational diabetes, their chances are 2 in 3 that it will return in future pregnancies. In a few women, however, pregnancy uncovers diabetes type I or diabetes type II. It is hard to tell whether these women have gestational diabetes or have just started showing their diabetes during pregnancy. These women will need to continue diabetes treatment after pregnancy. Many women who have gestational diabetes go on to develop diabetes type II years later. There seems to be a link between the tendency to have gestational diabetes and diabetes type II. Gestational diabetes and type II diabetes both involve insulin resistance. Certain basic life- style changes may help prevent diabetes after gestational diabetes. 112 Screening examination for gestational diabetes is carried out on pregnant women in all interviewed European regions with the exception of England (UK), Dublin/Mid-Leinster and Dublin/North-East (IE) and Sicily (IT) where this examination is not done in a methodical way through a screening programme. 113 6.3.2 Treatment and care Since diabetes is a chronic disease, special attention should be attached to treatment and care in order to avoid long-term damage. 6.3.2.1 Implemention of regional integrated care programmes With regard to integrated care programmes for diabetes, a look at the regional level gives in- teresting insights. Currently, six regions have implemented such a programme. These regions include North Rhine-Westphalia (DE), Saxony-Anhalt (DE), Emilia-Romagna (IT), Veneto (IT), Kaunas (LT) and England (UK). In addition it should be said that such a programme is planned in Upper-Austria (AT). 114 A look within country borders shows that for regional integrated care programmes for diabetes (type II) no differences can be observed between the two German regions. At the 112 American Diabetes Association http://www.diabetes.org/gestational-diabetes.jsp (17th July 2007). 113 Missing information: Veneto (IT), Madeira (PT) and Västra Götaland (SE). 114 Missing information: Madeira (PT) and Västra Götaland (SE). - 283 -

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Part II
IB417 - IIS RU