# Linked survey and statutory health insurance data evaluating healthcare utilization patterns and associated factors of persons with diabetes in Germany – latent class analysis

## TL;DR

This study identifies different healthcare utilization patterns among people with diabetes in Germany and finds that these patterns are linked to factors like age, sex, and mental health.

## Contribution

The study introduces a novel approach to diabetes care by identifying distinct healthcare utilization subgroups using latent class analysis.

## Key findings

- Four distinct healthcare utilization patterns were identified among people with diabetes in Germany.
- The 'high users with mental health care' group was younger, more female, and had lower quality of life and higher depression prevalence.
- The findings suggest a need for more personalized diabetes care beyond the current one-size-fits-all disease management programs.

## Abstract

Persons with diabetes mellitus have complex healthcare needs. Existing disease management programmes (DMPs) are based on a one-size-fits-all approach. However, individuals might require more individualised care. This study aims to identify groups with different patterns of healthcare utilization among people with diabetes in Germany and factors associated with these different patterns. A cross-sectional survey was conducted among a random sample from a statutory health insurance (SHI) with diabetes (n = 1332) and linked to longitudinal SHI data. Latent class analysis was used to identify subgroups with similar patterns of healthcare utilization and factors associated with different patterns. Four patterns of healthcare utilization were identified among people with diabetes: ‘low users’ (20.8% of the total sample); ‘low users with ophthalmologist visit’ (45.2%); ‘high users’ (26.5%); and ‘high users with mental health care’ (7.5%). The classes differed significantly in age, sex, type, duration and severity of diabetes, DMP membership, diabetes training, health-related quality of life, and prevalence of depression. The ‘high users with mental health care’ class was for example younger, more female, had a lower quality of life and the highest prevalence of depression. This study may provide a first basis for thinking about targeted care in Germany beyond DMPs.

The online version contains supplementary material available at 10.1038/s41598-025-95514-9.