Quality assessment of glucose measurement with regard to epidemiology and clinical management of diabetes mellitus in Germany

Peter B Luppa; Michael Zeller; Marija Pieper; Patricia Kaiser; Nathalie Weiss; Laura Vierbaum; Guido Freckmann

doi:10.3389/fmolb.2024.1371426

Quality assessment of glucose measurement with regard to epidemiology and clinical management of diabetes mellitus in Germany

Front Mol Biosci. 2024 Mar 20:11:1371426. doi: 10.3389/fmolb.2024.1371426. eCollection 2024.

Authors

Peter B Luppa¹, Michael Zeller¹, Marija Pieper¹, Patricia Kaiser², Nathalie Weiss², Laura Vierbaum², Guido Freckmann³

Affiliations

¹ Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar der Technische Universität München, Munich, Germany.
² INSTAND e.V., Gesellschaft zur Förderung der Qualitätssicherung in Medizinischen Laboratorien e.V., Düsseldorf, Germany.
³ Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany.

Abstract

Background: During the last decade, Germany has seen an increased prevalence and a redistribution from undetected to diagnosed diabetes mellitus. Due to this substantial epidemiological development, the number of people with documented type 2 diabetes was 8.7 million in 2022. An estimated two million undiagnosed subjects are to be added. Beyond that, the life expectancy of diabetic subjects is increasing due to more responsive health systems in terms of care. Possible reasons include improved screening of at-risk individuals, the introduction of HbA1c for diagnosis in 2010, and the higher use of risk scores. Additionally, quality aspects of the laboratory methodology should be taken into consideration.

Methods: Epidemiology and clinical management of diabetes in Germany are presented in the light of publications retrieved by a selective search of the PubMed database. Additionally, the data from German external quality assessment (EQA) surveys for the measurands glucose in plasma and HbA1c in whole blood, reviewed from 2010 until 2022, were evaluated. Above this, data concerning the analytical performance of near-patient glucometer devices, according to the ISO norm 15197:2013, were analyzed.

Results: Two laboratory aspects are in good accordance with the observation of an increase in the diabetes mellitus prevalence when retrospectively reviewing the period 2010 to 2022: First, the analytical performance according to the ISO norm 15197:2013 of the glucometer devices widely used by patients with diabetes for the glucose self-testing, has improved during this period. Secondly, concerning the EQA program of INSTAND, the number of participating laboratories raised significantly in Germany. The spreads of variations of the specified results for plasma glucose remained unchanged between 2010 and 2022, whereas for HbA1c a significant decrease of the result scattering could be observed.

Conclusion: These retrospectively established findings testify to an excellent analytical quality of laboratory diagnostics for glucose and HbA1c throughout Germany which may be involved in a better diagnosis and therapy of previously undetected diabetes mellitus.

Keywords: EQA schemes; HbA1c in whole blood; ISO 15197; diabetes management; diabetes prevalence; glucose in plasma.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The presented study had no dedicated funding and was performed as part of the authors’ professional employment.