Comparison Tool: Select Two Countries of Interest

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	Country of Interest Austria Belgium Bulgaria Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Ireland Italy Latvia Lithuania Luxembourg Malta Poland Portugal Romania Slovakia Slovenia Spain Sweden The Netherlands United Kingdom		Reference Country Austria Belgium Bulgaria Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Ireland Italy Latvia Lithuania Luxembourg Malta Poland Portugal Romania Slovakia Slovenia Spain Sweden The Netherlands United Kingdom
Abbreviation Three-letter country code	DEU		FRA
Country Official name of the country	Germany		France
Demographics and Epidemiology Population Size (0 - 14 years)	11487000		11022000
Is there a pediatric diabetes register?	yes		no
What is the scope?	three federal states, plus a widely disseminated system of quality control DPV
Name of the register	Baden-Württemberg, Sachsen and Nordrhein-Westfalen - national-wide DPV system
Remarks to the register	Although there is no national pediatric diabetes register reported in Germany, several diabetes registers exist at the level of federal states: Baden-Württemberg, Sachsen and Nordrhein-Westfalen. Moreover, most pediatric diabetes centres document their patients through the DPV system, which currently hosts the documentation of more than 17,000 patients < 18 years.		There is currently no national pediatric diabetes register reported in France but some regional registers are currently under development.
Were the country data published in the last Eurodiab report? (Lancet 2009;373(9680):2027-33)	yes		no
Are mortality data available?	no		data available from the past
Type 1 Diabetes Epidemiology Diabetes incidence rates (0-14y) average, new cases per 100,000 and year	15.5		15.0
Remarks to incidence data	Lancet 2009 - 373:2027: data 89 - 03 - the larger of the registers		age 0-15
Estimated number of cases with childhood diabetes (0-14y), total in the country	14600		14000
Remarks to the number of cases	source: Deutscher Gesundheitsbericht Diabetes		age 0-20, source: Surveillance &#195 - &#169 - pid&#195 - &#169 - miologique du diab&#195 - &#168 - te de l&#226 - &#128 - &#153 - enfant &#226 - &#128 - &#148 - Institut de veille sanitaire, 2007
Period of ascertainment of the above data
Source of the above epidemiological data
Type 2 Diabetes Summary of type 2 diabetes	According to the DPV, a German Pediatric Diabetes Registry, 4 to 5% of the newly diagnosed 11 to 18 year old children were classified as having type 2 diabetes. The national recommendations for the screening of type 2 diabetes in childhood are available, and published in the updated evidence-based guidelines.		There are no published data on the estimated proportion of type 2 diabetes in children and adolescents but it is estimated that approximately 5% of the children and adolescents with diabetes have type 2 diabetes. There are no national recommendations for the screening of type 2 diabetes in childhood.
Patient organizations The most important organization for children with diabetes in the country.	Bund diabetischer Kinder und Jugendlicher		Aide aux Jeunes Diab&#195 - &#169 - tiques
Its web address	www.bund-diabetischer-kinder.de		www.ajd-educ.org
Is this organization exclusively for childhood diabetes?	yes		yes
Organization for health professionals and physicians Organization for physicians and/or health professionals focused on diabetes.	Deutsche Diabetes Gesellschaft (DDG)		ALFEDIAM (Association de Langue Fran&#195 - &#167 - aise pour l'Etude du Diabete et des Maladies M&#195 - &#169 - taboliques)
Its web address.	www.deutsche-diabetes-gesellschaft.de		www.alfediam.org
Other organization for physicians and/or health professionals focused on diabetes.
Its web address.
Summary of the organization of the care	In Germany, qualified pediatric diabetologists have the main responsibility, they treat more than 80% of pediatric patients. In some cases a diabetologists for adults is designated to take care of pediatric diabetes. Pediatricians or general practitioners only prescribe glucometers and strips in a few cases.		Children are treated either in a specialised centre (generally University Hospital) or in general pediatric centres. Competence in pediatric diabetes care is in France is in hands of either a pediatrician or a diabetologist since there are no formal pediatric diabetologists in France. Diabetologists for adults and general practitioners are never or very rarely involved in pediatric diabetes care. In general, there is only limited supervision of pediatricians by diabetologists. However, diabetes seminars and trainings are organised for pediatricians.
Transition from pediatric to adult care Minimum age for transition from pediatric to adult diabetes care.	16		18
Usual age for transition from pediatric to adult diabetes care.	18		19
Maximum age for transition from pediatric to adult diabetes care.	21		20
Pediatric diabetes centres Are there officially recognized pediatric diabetes centres in your country?	yes		no
Who renders the status of the centre?	Diabetes Society
Are there defined criteria for being a center?	yes
Is the status of the centre permanent?	no, reapplication is necessary
Does a centre have to participate in a QC programme?	yes, in a mandatory unified program
Remarks to participation in a national QC system
Quality control of pediatric diabetes care Is there a system of quality control in pediatric diabetes care at the national level?	yes		no
Who organizes this system?	DPV, FQSD (Forum Qualitätssicherung in der Diabetologie)
Glycated hemoglobin levels	1		0
Other indicators
What is the feedback from the system?	electronic on-line statistics
Frequency of DKA with hospitalization	1		0
Frequency of severe hypoglycemia requiring assistance	1		0
Growth data	1		0
Data on quality of life	0		0
Microalbuminuria levels	0		0
Further indicators	1		0
Education of a diabetic patient Is the content of education of diabetic childred regulated?	no		yes
Who determines the content of education?	individual centres		a national plan / guidance for education
Is education reimbursed?	with limits		with limits
Remarks to education	Education for children and adolescents with diabetes in Germany is partly reimbursed by the health insurance company which foresees in a re-education every 2 years in an outpatient setting.		Reimbursement of education is covered by the National Social Security. More specifically, education is often covered within the cost of hospitalisation: education at diagnosis, during a week-long hospitalisation or in a day-care unit. Education is also provided during Diabetes Camps which are reimbursed for children and adolescents with diabetes.
National diabetes program/plan Is there a national diabetes plan / program?	no		no
Details on the diabetes plan?	There is currently no national diabetes plan in Germany. According to the Diabetes Audit (2008), a national plan is in preparation. However, the first draft of this plan has been discussed controversially and the further progress is presently unclear.		France currently does not have a national diabetes programme. The previous diabetes programme ended in 2005.
National criteria for diabetes control in pediatric age Are there defined national standard criteria for diabetes control in pediatric age??	yes		yes
Who issued these criteria?	Deutsche Diabetes Gesellschaft (DDG)/AGPD		HAS following ISPAD
Have they been published in professional journals?	yes		yes
If no, do you use adult criteria of diabetes control?
National guidelines defining the surveillance for chronic diabetes complications Are there national guidelines defining the surveillance for chronic diabetes complications and diabetes-associated diseases that are applicable to pediatric practice?	yes		yes
Who issued these guidelines?	DDG/AGPD		HAS
Are they ISPAD compliant?	in most instances		yes, completely
diabetic retinopathy	1		1
diabetic nephropathy	1		1
diabetic neuropathy	0		1
autoimmune thyroid disease	1		1
celiac disease	1		1
hyperlipidemia	1		1
psychological disorders	1		0
other, please list	0		0
other complications - list
Monogenic diabetes Is MODY analysis available?	yes		yes
What types of MODY are tested in the country?	all MODY types		all MODY types
What types of MODY are testes abroad?	-

Current status of reimbursement for diabetes treatment

Injectable insulin	yes		yes
Rapid acting insulin analogues	yes		yes
Long acting insulin analogues	yes		yes
Insulin pens	yes		yes
Insulin pumps	yes		yes
Blood glucose monitoring strips	restricted		yes
Blood glucose monitoring meters	restricted		yes
Continuous glucose monitoring – intermittent/diagnostic use	restricted		unknown
Continuous glucose monitoring – continuous use	restricted		no
Lancets	yes		yes
Lipid testing	yes		yes
Micro/macro albuminuria	yes		yes
Retinopathy screening	yes		yes
Blood pressure meters	restricted		no
Education	restricted		restricted
Psychologists	restricted		no
Dietician	restricted		no
remarks to reimbursment	While the majority of diabetes treatment is currently reimbursed, there is growing controversy surrounding the reimbursement decisions for many of the new treatments. Restrictions on the reimbursement for diabetes treatment are expected over the next two years.		While the majority of diabetes treatment is currently reimbursed, there is growing controversy surrounding the reimbursement decisions for many of the new treatments. Restrictions on the reimbursement for diabetes treatment are expected over the next two years.