Aims/hypothesis

The aim of the study is to describe the time trend of type 2 diabetes incidence in the largest state of Germany, Bavaria, from 2012 to 2021, and to compare the incidence rates during the pandemic period (2020–2021) to the pre-pandemic period (2012–2019).

Methods

This secondary data analysis uses health claims data provided by the Bavarian Association of Statutory Health Insurance Physicians (KVB), covering approximately 11 million insurees, accounting for 85% of the total population of Bavaria, Germany. Newly diagnosed type 2 diabetes cases in adults (≥20 years) coded as E11 (Diabetes mellitus, Type 2) or E14 (Unspecified diabetes mellitus) under ICD-10, German modification (ICD-10-GM) for the study period 2012 to 2021 were included. Annual and quarterly age-standardised incidence rates (ASIR) stratified by sex, age and region were calculated using the European standard population. Sex-specific crude incidence rates (CIR) were calculated using 10-year age groups. Regression analyses adjusted for time trends, seasonal effects, and pandemic effects were used to analyse the incidence trend and to assess the effect of the pandemic.

Results

Overall, 745,861 new cases of type 2 diabetes were diagnosed between 2012 and 2021: 50.4% (376,193 cases) in women. The male/female ratio remained stable over the observation period, while the median age at diagnosis decreased from 61 to 58 years in men and from 66 years to 61 years in women. ASIR were consistently higher for men compared with women, with the yearly difference remaining stable over time (2012: 18%; 2021: 20%). An overall decreasing trend in ASIR was observed during the study period, with a strong decrease from 2012 to 2017, followed by a less pronounced decline from 2018 to 2021 for both sexes. For men, ASIR decreased from 1514 per 100,000 person-years in 2012 to 995 per 100,000 person-years in 2021 (4.6% average annual reduction), and for women from 1238 per 100,000 person-years in 2012 to 796 per 100,000 person-years in 2021 (4.8% average annual reduction). This downward trend was also observed for age groups above 50 years. Regression analyses showed no significant change in incidence rates during the pandemic period (2020 and 2021) compared with the pre-pandemic period.

Conclusions/interpretation

For the first time, a 10-year incidence trend of type 2 diabetes is reported for Germany, showing a strong decline from 2012 to 2017, followed by a less pronounced decline from 2018 to 2021. The incidence trend of type 2 diabetes appears not to have been affected by the first 2 years of the COVID-19 pandemic. Despite an overall increasing prevalence, the incidence is decreasing, potentially resulting from robust screening by family physicians, reducing the median age at diagnosis by 3 to 5 years. However, further investigation is needed to fully identify the reasons for the declining incidence trend. Continued incidence monitoring is necessary to identify the long-term trend and the potential effect of the pandemic on diagnoses of type 2 diabetes.

Graphical Abstract

中文翻译：

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德国2012年至2021年2型糖尿病发病趋势：1100万法定参保人健康申报数据分析

目标/假设

该研究的目的是描述德国最大的州巴伐利亚州2012年至2021年2型糖尿病发病率的时间趋势，并将大流行期间（2020-2021年）的发病率与大流行前的发病率进行比较期间（2012-2019）。

方法

本次二次数据分析采用巴伐利亚法定健康保险医师协会（KVB）提供的健康理赔数据，覆盖约1100万参保人，占德国巴伐利亚州总人口的85%。 2012年至2012年研究期间根据ICD-10德国修订版（ICD-10-GM）编码为E11（糖尿病，2型）或E14（未明确的糖尿病）的成人（≥20岁）新诊断的2型糖尿病病例2021 年也包括在内。使用欧洲标准人口计算按性别、年龄和地区分层的年度和季度年龄标准化发病率（ASIR）。使用 10 岁年龄组计算特定性别的粗发病率 (CIR)。根据时间趋势、季节性影响和大流行影响进行调整的回归分析用于分析发病趋势并评估大流行的影响。

结果

总体而言，2012 年至 2021 年间，新诊断出 745,861 例 2 型糖尿病病例：其中 50.4%（376,193 例）为女性。在观察期内，男女比例保持稳定，而男性诊断时的中位年龄从 61 岁下降到 58 岁，女性从 66 岁下降到 61 岁。与女性相比，男性的 ASIR 始终较高，并且随着时间的推移，年度差异保持稳定（2012 年：18%；2021 年：20%）。研究期间观察到 ASIR 总体呈下降趋势，从 2012 年至 2017 年，男女的 ASIR 下降幅度较大，随后从 2018 年至 2021 年，下降幅度不太明显。对于男性来说，ASIR 从 2012 年的每 10 万人年 1514 人下降到 2021 年的每 10 万人年 995 人（年均减少 4.6%），而女性的 ASIR 从 2012 年的每 10 万人年 1238 人下降到每 10 万人年 796 人2021 年（年均减少 4.8%）。 50 岁以上年龄组也观察到这种下降趋势。回归分析显示，与大流行前相比，大流行期间（2020年和2021年）的发病率没有显着变化。

结论/解释

德国首次报告了 2 型糖尿病的 10 年发病率趋势，显示 2012 年至 2017 年大幅下降，随后 2018 年至 2021 年下降不太明显。2 型糖尿病的发病率趋势似乎并没有下降。受到 COVID-19 大流行前两年的影响。尽管总体患病率不断上升，但发病率正在下降，这可能是由于家庭医生进行了强有力的筛查，将诊断时的中位年龄降低了 3 至 5 岁。然而，需要进一步调查以充分查明发病率趋势下降的原因。有必要持续监测发病率，以确定疫情大流行对 2 型糖尿病诊断的长期趋势和潜在影响。

图形概要