Advantages of DDG-certified hospitals for hospitalized patients with diabetes - A nationwide DRG analysis in Germany

AimHospital certifications by the German Diabetes Association (DDG) are intended to ensure high-quality diabetological care. We aimed to compare Germany-wide characteristics and outcomes of hospitalized adults with diabetes in diabetes certified vs. non-diabetes certified hospitals. MethodsWe analyzed in the German Diagnosis Related Groups (DRG) statistics for 2021-2023 all inpatient cases aged [≥] 20 years with and without diabetes (all types) as a main or secondary diagnosis based on ICD-10 codes. Using Wilcoxon and Chi2-tests, characteristics of inpatient cases with diabetes were compared between diabetes certified hospitals (n=300) and non-diabetes certified hospitals (n=1,103). ResultsOf 43.4 million total inpatient cases in the period from 2021 to 2023, 8.1 million (18.5%) had a documented diabetes diagnosis (94% of the cases as secondary diagnosis). In certified hospitals, 19.0% of inpatient cases had diabetes compared to 18.3% in non-certified hospitals. Although inpatient cases with diabetes had more hospital-acquired and procedure-related complications (17.2% vs. 16.7%, p<0.001), as well as higher rates of hypoglycemia (3.2% vs. 2.1%, p<0.001) and metabolic disorder (diabetic ketoacidosis: 0,5% vs. 0,4%; acute metabolic disorder with multiple complications: 2.3% vs. 1.0%, p<0.001) in certified hospitals vs. non-certified hospitals, in-hospital mortality for all diabetes cases was similar (4.5% in both). However, among those with diabetes as the main diagnosis, in-hospital mortality was significantly lower in diabetes certified hospitals (type 1 diabetes: 0.6% vs. 1.1% and type 2 diabetes: 2.3% vs. 2.9%, both p<0.001), despite a higher complication burden. ConclusionsHospitalized people with diabetes as the main diagnosis had lower in-hospital mortality in diabetes-certified hospitals, even though they had a higher disease burden. These findings suggest that expanded use of DDG-certified departments, including consultation services for patients whose diabetes is a secondary diagnosis, may further improve clinical outcomes.