NDP 2012 – 2022
Annex 2
RESERVES IN THE CARE FOR DIABETIC PATIENTS IN THE CZECH
REPUBLIC
Data on mortality and data on treatment of diabetes and its comorbidities (including
hypertension, dyslipidemia and obesity), use of recommended examination and achieving the
target values in the Czech Republic are obtained from IHIS data, General Health Insurance
Company data, epidemiological study of CDS, Valetudo project and IDN micro project.
1. Mortality
The total mortality of diabetic patients is reducing in the Czech Republic. However, the
mortality appears to be still higher in some age groups in comparison with mortality of the
general population (table 1+2).
Table 1 – patients with detected antidiabetic therapy according to data of the General Health
Insurance Company in 2006 who died in 2006 – comparison of mortality according to age of
population data in men
Table 2
Patients with detected antidiabetic therapy according to GHI company data in 2006 who died
in 2006 – comparison with mortality according to age to population data in women
2. Hyperglycaemia treatment
Glycated hemoglobin (HbA1c) is the basic indicator for successful treatment of
hyperglycaemia. The total overview of number of glycated hemoglobin examination in all
diabetes mellitus patients in 2002-2006 can be seen in graph 1. The graph depicts that HbA1c
is examined only 0,8 times a year in average. It means that there is insufficient number of
recommended frequency- 2-4x per year and 50% of patients has not been examined at all (see
graph 2). The situation concerning diabetic patients treated by insulin is much better (see
graph 3). Education is not use sufficiently in the hyperglycaemia treatment (graph 6).
Graph 1 – the total overview of glycated hemoglobin examinations according to the General
Health Insurance Company in 2002-2006
Graph 2- the total overview of glycated hemoglobin examination in all diabetes mellitus
patients according to the General Health insurance company data in 2002-2006
Graph 3 - The total overview of glycated hemoglobin examinations in diabetes mellitus
patients treated by insulin according to data of the General Health Insurance Company in
2002-2006
Metformin is the basic oral glucose-lowering drug in treatment of patients with 2 type
diabetes. It should be used immediately after diabetes diagnosis. Graph 4 shows the structure
of hyperglycaemia treatment according to IHIS data in which 21% of patients are treated by
diet and the treatment is not probably sufficient.
Graph 4
3. Screening diabetes complications and other risk factors
Data of the General Health Insurance Company (graph 5) show that the other risk factors are
not examined in sufficient frequency (lipids should be examined 1x a year in each diabetic
patient) and active screening of incipient stages of late diabetes complications
(microalbuminuria) is not performed.
Graph 5
Graph 6
Complications screening (nephropathy and retinopathy) of diabetes is not sufficient.
Risk factors are not examined.
Pharmacotherapy of comorbidities
Other risk factors are not examined at sufficient frequency as well (lipids should be examined
1x a year in each diabetic patient as well as microalbuminuria) and active screening of
incipient stages of late diabetes complications (microalbuminuria) is not examined as well.
Finally, intervention of risk factors from the standpoint of quantity does not correspond with
expert recommendation in all cases – 70 – 80% of patients should be treated by hypolipidemic
therapy (graph 7). There is insufficient pharmacotherapy of diabetes comorbidities
Graph 7 – patients treated by glucose-lowering drugs: the total overview of patient treatment
by medicals influencing cardiovascular system
4. Average values of HbA1c, blood pressure, plasma lipids and weight in diabetic
patients in the Czech Republic
The results of epidemiological investigation initiated by CDS and data registered of DEPAC
etc. show insufficient control of hyperglycaemia, plasma lipids, hypertension in diabetic
patients. Graph 8 shows that only 5% of diabetic patients reach the required values in all
monitored parameters in the Czech Republic. However, there is still a noticeable
improvement in comparison with the year of 2002.
Graph 8
5. Conclusions
HbA1c has not been examined sufficiently. Education and pharmacotherapy are not used
consistently in the treatment of hyperglycaemia. Screening of complications (nephropathy and
retinopathy) of diabetes is not sufficient. Risk factors (hypertension and dyslipidemia) are not
examined and treated consistently. In the Czech Republic, only 5% of patients with type 2
diabetes reach satisfactory values of HbA1c, serial lipids and blood pressure.