Austrian Court of Audit sees considerable room for improvement in diabetes prevention and care

18.10.2019 - Another audit was carried out on AustriaTech mobility technologies and innovations

Der Mittelwert des Body-Mass-Index aller Stellungspflichtigen im Zeitraum 1980 - 2017 stieg von 22,1 im Jahr 1980 auf 23,7 im Jahr 2017 an. Es ist ein Ost-West-Gefälle festzustellen. Über den gesamten Zeitraum waren die Werte im Osten höher als im Westen. - Copyright:

Today the Austrian Court of Audit (ACA) published the following reports: 

  • AustriaTech - Mobility Technologies and Innovations
  • Diabetes Prevention and Care

In its report “Diabetes Prevention and Care” the ACA points to qualitative problems with regard to the care provided for persons suffering from type 2 diabetes. Furthermore, it detected shortcomings in the prevention of diabetes and a poor management of data. 

According to extrapolations of social insurance providers in 2016, some 506,700 persons were afflicted with type 2 diabetes in Austria. Estimates show that up to 294,000 cases of type 2 diabetes have not been diagnosed in Austria.

Diabetes is a major challenge for the Austrian public healthcare system due to the increase in outbreaks, the health impairments and the financial consequences. The audit was carried out in the independent healthcare sector with a focus on the regional health insurance organizations for Lower Austria and Tyrol in the period of 2013 to 2017.

Incomplete data

Type 2 diabetes mellitus (type 2 diabetes) is a chronic metabolic disease characterized by elevated levels of blood sugar. Exact figures on the persons afflicted do not exist. In Austria the number of diabetes sufferers is determined based on the purchase of relevant medicines via the health insurance providers. According to such calculations, the number of persons suffering from diabetes increased by about 10 per cent in the period of 2013 to 2016 - from some 461,484 in 2013 to some 506,690 in 2016. The ACA recommends to establish valid and complete databases on diabetes. Furthermore, regional and gender-related specificities should be analysed and taken into account for the prevention and care. The Austrian report on diabetes 2017 (Österreichischer Diabetesbericht 2017), for example, reveals that women with a low social status tend to have a higher risk of developing diabetes.       

Only 13 per cent of diabetes sufferers participate in a structured treatment programme 

Since 2017, the disease management programme for diabetes “Active Therapy – Getting a Grip on Diabetes” (“Therapie aktiv – Diabetes im Griff”) has been providing a structured care for diabetes patients in Austria. The programme is to ensure a uniform treatment.

The disease management programme for diabetes envisages for example an annual examination of the fundus of the eye. In end-2017, 66,000 persons were enrolled in the programme. This equals around 13 per cent of the persons suffering from diabetes. In comparison, Germany saw a rate of participation of some 50 per cent of diabetes sufferers in such a disease management programme in the same period. 

The ACA critically points out that about two-thirds of social health insurance accredited general physicians and specialists for internal medicine did not participate in the disease management programme in Lower Austria. Tyrol had launched a pilot project with twelve physicians in 2017.

Remote healthcare services are to improve the monitoring of vital functions 

The introduction of remote monitoring, namely the monitoring of vital functions of diabetes sufferers without the requirement to pay a visit to the physician, was part of the Federal Target Control Agreement 2017 (Bundes–Zielsteuerungsvertrag 2017). At the time of the audit, there was no extensive provision of remote healthcare services. Furthermore, such services were not included in the disease management programme.

Related pilot projects initiated by the regional health insurance organization for Tyrol and the Austrian insurance fund for miners and persons employed with the federal railways, however, showed positive results. The regular digital documentation of measured values and the monitoring of vital parameters (e.g. blood sugar) by the attending physicians increased the safety of patients. An improved quality of care and of life, the mitigation of risks to develop secondary diseases and an improved management of data were among the other advantages.

Although remote monitoring cannot entirely replace the direct contact with a physician, it can be a sound complement to the treatment of diabetes. The ACA therefore recommends a timely establishment of remote healthcare services.

Shortcomings in early detection and prevention 

Besides the preventative check-ups, in which some 990,000 insured persons participated in 2016, no further comprehensive initiative had been prepared for the early detection of diabetes in Austria. This is despite the fact that according to the Austrian report on diabetes 2017 the number of undiagnosed diabetes diseases is estimated at about 147,000 to 294,000 cases. 

In 2017, the Federal Ministry of Health devised a new diabetes strategy, which was aimed at reducing the number of diabetes cases. However, no improvement was observed for significant risk factors such as poor diet, physical inactivity, alcohol consumption and smoking. In 2016, some 15 per cent of the Austrian population was obese and the trend has been upwards since 2006.

The ACA furthermore analysed the data of army conscripts. The average body mass index of the young men increased from 22.1 in 1980 to 23.7 in 2017.

One of the objectives of the Austrian Nutrition Action Plan (Nationaler Aktionsplan Ernährung) is to reduce the intake of salt and added sugar. In 2011 the Federal Ministry of Health concluded an agreement with the bakers’ guild to lower the salt content in bread and pastry. Consequently, the consumption of salt decreased by some 82 tons from 2010 to 2015. The ACA recommends to the Federal Ministry of Health to work towards a similar agreement with the food industry to reduce the sugar content.

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Report: Diabetes Prevention and Care

From February to June 2018, the ACA carried out an audit of diabetes prevention and care in the independent healthcare sector.

Report: Diabetes Prevention and Care Download
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Report: AustriaTech – Gesellschaft des Bundes für technologiepolitische Maßnahmen GmbH

From April to June 2018, the ACA carried out an audit of AustriaTech – Gesellschaft des Bundes
für technologiepolitische Maßnahmen GmbH (Federal association for technology policy measures).

Report: AustriaTech – Gesellschaft des Bundes für technologiepolitische Maßnahmen GmbH Download

Central recommendations

  1. AustriaTech and the Federal Ministry for Transport, Innovation and Technology should clearly structure the existing links between the association and the ministry and document the established division of tasks in writing. 

  2. In the spirit of transparent budgeting and accounting, an increase in the headcount of the ministry via temporary hiring contracts should be avoided. 

  3. AustriaTech should strive to attain a high share of innovative projects in order to sustainably safeguard and increase the added value for citizens through the implementation of innovations.