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Auzanneau, M.* ; Fritsche, A. ; Eckert, A.J.* ; Seidel-Jacobs, E.* ; Heni, M.* ; Lanzinger, S.*

In-hospital outcomes of adults with diabetes treated in certified vs. non-certified hospitals: A nationwide analysis of German DRG statistics.

Front. Health Serv 6, DOI: 10.3389/frhs.2026.1782882 (2026)
Verlagsversion Forschungsdaten DOI
Open Access Hybrid
Creative Commons Lizenzvertrag
Introduction: Certifications for inpatient diabetes care aim to improve quality of care and patient safety. However, the benefits of treatment in hospitals certified by the German Diabetes Association (DDG) have not yet been evaluated. Methods: In the national diagnosis-related groups (DRG) statistics for the 3-year period 2021-2023, we analyzed all inpatient cases with diabetes (all types, primary or secondary diagnosis) aged >= 20 years. Odds ratios for in-hospital mortality and differences in the length of hospital stay were compared between diabetes certified (DCH) and non-certified hospitals (NDCH) using hierarchical multiple regression models. Results: Of 43.4 million total inpatient cases in 2021-2023 in Germany, 8.1 million (18.5%) had a documented diabetes diagnosis. The prevalence of diabetes was 19.0% in the 300 DCH compared to 18.3% in the 1,103 NDCH, but 60.7% of all inpatients with diabetes were treated in NDCH. Overall, the mortality for inpatients with diabetes in DCH was lower (3.11% [95%-CI: 3.09-3.14] vs. 3.16% [3.14-3.18], OR: 0.98 [0.97-0.99], p = 0.002) and the hospital stay was shorter (7.93 days [7.79-8.07] vs. 8.96 days [8.87-9.05], p < 0.001) than in NDCH. After stratification, the differences in mortality in DCH vs. NDCH were significant for cases with diabetes as primary diagnosis (OR for type 1 diabetes: 0.59 [0.49-0.70], OR for type 2 diabetes: 0.87 [0.84-0.91], both p < 0.001), with ketoacidosis (DKA): 0.88 [0.80-0.97], p = 0.009), and with hypoglycemia: 0.79 [0.76-0.83], p < 0.001), but not for cases with diabetes as secondary diagnosis. Conclusion: This nationwide analysis indicates a significantly reduced mortality in diabetes certified hospitals for people with diabetes as primary diagnosis, with DKA or hypoglycemia. Prospective comparisons stratified by hospital characteristics are needed to deepen these results.
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Publikationstyp Artikel: Journalartikel
Dokumenttyp Wissenschaftlicher Artikel
Schlagwörter accreditation; certification; diabetes care; inpatient care; quality improvement; Accreditation
ISSN (print) / ISBN 2813-0146
e-ISSN 2813-0146
Zeitschrift Frontiers in Health Services
Quellenangaben Band: 6 Heft: , Seiten: , Artikelnummer: , Supplement: ,
Verlag Frontiers Media S.A.
Verlagsort Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
Institut(e) Institute of Diabetes Research and Metabolic Diseases (IDM)
Förderungen German Diabetes Association (DDG)