Risks of comorbidities and complications of diabetes for the evaluation of the St. Vincent goals for diabetes mellitus

Home Research/Institutes Institute for Health Services Research and Health Economics Patient-relevant outcomes Risks of comorbidities and complications of diabetes for the evaluation of the St. Vincent goals for diabetes mellitus

The St. Vincent Declaration, enacted in 1989, stipulated concrete goals for the improvement of diabetes care in Europe. The aim was to reduce relevant complications of diabetes mellitus – amputation, end-stage renal disease, blindness, myocardial infarction and stroke – by 30-50 %. Trend analyses from recent years indicated a positive development overall. The ISE has been carrying out continuous research to evaluate the St. Vincent goals since 2008.


The objective of the project is to estimate the incidence rates and relative risks of the following complications of diabetes in the population with compared to the population without:

  • Amputations
  • End-stage renal disease
  • Myocardial infarction
  • Strokes
  • Blindness

Project Lead / Contact Person



  • BARMER GEK, Berlin
  • Betriebskrankenkassen (BKK), Team Gesundheit Gesellschaft für Gesundheitsmanagement mbH, Essen
  • AOK-Bundesverband GbR, Wissenschaftliches Institut der AOK (WIdO), Berlin
  • Diabetic Foot Study Group (DFSG) of the European Association for the Study of Diabetes (EASD)
  • Diabetesklinik Soest
  • Department für Versorgungsforschung, Universität Oldenburg
  • Landesgesundheitsamt Baden-Württemberg, Stuttgart
  • Kommunaler Sozialverband Sachsen, Chemnitz
  • Nephrologisches Zentrum, Mettmann
  • Nephrologisches Zentrum, Villingen-Schwenningen
  • Interdisziplinäres Zentrum für Health Technology Assessment und Public Health (IZPH), Erlangen PMV
  • Forschungsgruppe (Primärmedizinische Versorgung), Universität zu Köln
  • Robert Koch Institut (RKI), Berlin
  • Helmholtz-Zentrum, München


  • Federal Ministry of Health (BMG)
  • Deutsche Diabetes Stiftung


Various data sources are consulted for the analyses: health insurance data (amputations, renal replacement therapy), dialysis centers (renal replacement therapy), Augsburg heart attack register, Erlangen stroke register, administrative files of the welfare administration (collection of newly approved blindness allowance recipients). The population with diabetes is estimated using population-based data (health insurance, health surveys). Incidence of the complications as well as the relative and attributable risks are estimated, comparing populations with and without diabetes. Time trends are analyzed using multivariate regression models.



Selected Publications

  1. Claessen H, Narres M, Haastert B, Arend W, Hoffmann F, Morbach S, Rümenapf G, Kvitkina T, Friedel H, Günster C, Schubert I, Ullrich W, Westerhoff B, Wilk A, Icks A. Lower-extremity amputations in people with and without diabetes in Germany, 2008–2012 - an analysis of more than 30 million inhabitants. Clinical Epidemiology 2018. doi: 10.2147/CLEP.S146484
  2. Claessen H, Kvitkina T, Narres M, Trautner C, Zöllner I, Bertram B, Icks A. Markedly Decreasing Incidence of Blindness in People with and People without Diabetes in Southern Germany. Diabetes Care. 2018 Jan 9. pii: dc172031. doi: 10.2337/dc17-2031. [Epub ahead of print]. PMID: 29317450
  3. Icks A, Claessen H, Kvitkina T, Narres M, Weingärtner M, Schwab S, Kolominsky-Rabas PL. Incidence and relative risk of stroke in the diabetic and the non-diabetic population between 1998 and 2014: A community-based stroke register. PLoS One. 2017 Nov 16; 12(11):e0188306. doi: 10.1371/journal.pone.0188306. eCollection 2017.
  4. Claessen H, Genz J, Bertram B, Trautner C, Giani G, Zöllner I, Icks A. Evidence for a considerable decrease in total and cause-specific incidences of blindness in Germany. Eur J Epidemiol 2012; 27(7):519-24
  5. Icks A, Haastert B, Genz J, Giani G, Hoffmann F, Trapp R, Koch M. Incidence of renal replacement therapy (RRT) in the diabetic compared to the non-diabetic population in a German region, 2002-2008. Nephrol Dial Transplant 2011 (Jan; 26(1): 264-9
  6. Icks A, Scheer M, Genz J, Giani G, Glaeske G, Hoffmann F. Stroke in the diabetic and non-diabetic population in Germany. Relative and attributable risks, 2005-2007. J Diab Compl 2011 Mar-Apr; 25(2):90-6
  7. Genz J, Scheer M, Trautner C, Zöllner I, Giani G, Icks A. Reduced incidence of blindness in relation to diabetes mellitus in southern Germany? Diabetic Medicine 2010 Oct; 27(10): 1138-43
  8. Icks A, Dickhaus T, Hörmann A, Heier M, Giani G, Kuch B, Meisinger C. Differences in trends in estimated incidence of myocardial infarction in non-diabetic and diabetic people: Monitoring Trends and Determinants on Cardiovascular Diseases (MONICA)/Cooperative Health Research in the Region of Augsburg (KORA) registry. Diabetologia 2009; 52: 1836-1841
  9. Icks A, Haastert B, Trautner C, Giani G, Glaeske G, Hoffmann F. Incidence of lower-limb amputations in the diabetic compared to the non-diabetic population. Findings from nationwide insurance data, Germany, 2005-2007. Exp Clin Endocrinol Diabetes 2009; 117: 500-504

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