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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

Prevalence, incidence and concomitant co-morbidities of type 2 diabetes mellitus in South Western Germany - a retrospective cohort and case control study in claims data of a large statutory health insurance

BMC Public Health > Ausgabe 1/2015
Michael W. J. Boehme, Gisela Buechele, Julia Frankenhauser-Mannuss, Jana Mueller, Dietlinde Lump, Bernhard O. Boehm, Dietrich Rothenbacher
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-015-2188-1) contains supplementary material, which is available to authorized users.
Bernhard O. Boehm and Dietrich Rothenbacher contributed equally to this work.

Competing interests

JF-M and DL are employees of the AOK-BW. Otherwise the authors declare that they have no competing interests.

Authors’ contributions

JFM and DL had access to the primary data only. All authors had access to the aggregated data in the study. MWJB wrote the initial drafts. The study concept and design was made by MWJB, JFM, and BOB. JFM, DL, and JM did the acquisition and editing of data. MWJB, GB, and DR analyzed the data. The statistical analysis was carried out by GB. Critical revision and completion of the manuscript for important intellectual content did MWJB, GB, BOB, and DR. The study was supervised by DR. All authors read and approved the final manuscript.



Type 2 diabetes mellitus (T2DM) has become a world-wide epidemic. This chronic metabolic disease has a major impact on life expectancy and on quality of life. The burden of this disease includes a number of co-morbidities. However, estimates of prevalence, incidence and associated diseases as well as the current temporal development and regional differences are largely missing for South Western Germany.


Lifetime diagnosis-based prevalence, incidence and presence of concomitant co-morbidities were examined between the years 2007 and 2010 in the claims data set of all insured persons of the AOK Baden-Wuerttemberg, a large statutory health insurance. The analysis was based on the respective WHO-ICD-10 codes. Data were standardized for age and sex on the residential population of about 10 million inhabitants of South Western Germany.


The total study cohort involved approximately 3.5 million persons each year. The standardized diagnosis-based prevalence (SDP) of T2DM rose from 6.6 %, 7.4 %, 8.0 %, up to 8.6 % in the years 2007 to 2010. Yearly SDP was between 14.0 % and 18.9 % at an age range of 60 to 64 years and between 26.7 % and 31.8 % at an age of 75 years or older. In the year 2010 the regional distributions of standardized diagnosis-based prevalence were between 7.6 % and 11.6 %, respectively. Incidence rates were 8.3 in 2008, 7.8 in 2009, and 8.7 in 2010 (all rates per 1000). The excess disease risk (odds ratio) of T2DM was for adiposity 2.8 to 3.0, hypertension 2.4 to 3.7, coronary heart disease 1.8 to 1.9, stroke 1.7 to 1.8, renal insufficiency 2.8 to 3.4, and retinopathy 2.8 to 2.9 in the years 2007 to 2010. These co-morbidities appeared several years earlier compared to the non-diabetic population.


T2DM is common and increasing in South Western Germany. In particular a quarter of the population in higher ages was afflicted by T2DM. Interestingly a region-specific pattern was observed as well as an increase in numbers during earlier years in life. Our data underline the need for diabetes awareness programmes including early diagnosis measures as well as structured and timely health surveys for major diseases such as T2DM and its concomitant co-morbidities.
Additional file 1: Burden of selected concomitant co-morbidities (2007–2010). The table shows the standardized prevalence ratios for adiposity and several vascular determined concomitant diseases comparing insured persons with and without type 2 diabetes mellitus (T2DM) for the years 2007 to 2010. The prevalence rates were standardized for age and sex on the residual population of South Western Germany of the respective year with 95 % confidence intervals (CI) (SPR = standardized prevalence ratio) (Boehme et al. Additional file 1). (PDF 111 kb)
Additional file 2: Semi-maximum prevalence and interpolated age shift of selected concomitant co-morbidities (2007–2010). The Table shows the age and prevalence of concomitant co-morbidities at semi-maximum values comparing insured persons with and without type 2 diabetes mellitus (T2DM) after standardization for age and sex on the residual population of South Western Germany of the respective year. The data for the years 2007 to 2010 are shown. R2 is the goodness of fit from the respective regression model calculating the curves. For this analysis the age groups of 20 years and older were considered only (Boehme et al. Additional file 2). (PDF 112 kb)
Additional file 3: Excess risk of disease for selected concomitant co-morbidities (2007–2010). The table shows the prevalences of concomitant co-morbidities comparing all persons with type 2 diabetes mellitus (T2DM) and respective controls in a case–control-study for the years 2007 to 2010. The controls are matched individually by age and sex. The prevalence rates as well as the respective odds ratios are calculated with 95 % confidence intervals (CI). This analysis was performed without standardization (Boehme et al. Additional file 3). (PDF 110 kb)
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