Contextual factors as risk factors for diabetes

Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose levels. In particular, the risk of developing type 2 diabetes (adult-onset diabetes) is influenced by individual, behavior-based factors, such as physical inactivity, regularly high consumption of sugar-sweetened beverages and smoking, and additionally by contextual factors. These include living, working, and environmental conditions, but also health policies. Taking into account literature research, expert knowledge and data availability for Germany, the following contextual factors were integrated in the diabetes surveillance:

Prevention Expenditures

Prevention programs, such as physical activity classes in workplaces and schools, can help reduce the disease burden of type 2 diabetes and other non-communicable diseases. Adequate funding for prevention programs is important. In 2020, €176 per inhabitant was spent on prevention. This corresponds to a proportion of 3.3% of total health expenditure. The proportion of prevention spending in health expenditure has remained relatively constant over the past 25 years.

Tobacco Control

Smoking cigarettes and other tobacco products is one of the most important risk factors for the development of non-communicable diseases such as lung cancer, cardiovascular disease, and type 2 diabetes. Since measures to reduce the proportion of smokers can make a significant contribution to reducing the burden of disease in the population, the evaluation of tobacco reduction policies plays an important role. In a European comparison, German tobacco control ranks last in 2019 and has made relatively little progress over the past 20 years.

Consumer Price Index & Food Taxation

The consumer price index measures the average price development of goods which private households buy for consumption purposes. In addition to annual changes in the consumer price index (equivalent to the inflation rate), food taxation in accordance with statutory sales tax rates also has an impact on food prices. Between 2015 and 2020, an above-average price increase can be observed for some food products, including fruits and vegetables. Regular consumption of fruits and vegetables is described as reducing the risk of type 2 diabetes and some other non-communicable diseases. In contrast, there is little price change for ready-made meals and confectionery, increased consumption of which is associated with increased risk for type 2 diabetes and other non-communicable diseases. In contrast, the 7% sales tax rate on food has remained constant since 1990. In contrast, the sales tax rate on beverages has steadily increased from 14% to 19% since 1990. Food and beverages are not taxed in Germany on the basis of their health value.

Use of means of transport

People's physical activity is influenced by their choice of transportation. Lack of physical activity is an important risk factor for the development of obesity and non-communicable diseases such as type 2 diabetes. In Germany, the car is most frequently used as the main means of transport by around 40% of the population. About one-fifth of the population travels mainly on foot and about one-tenth mainly by bicycle. Public transport is the main means of transport used by one tenth of the population. While no temporal trend can be observed for car and public transport users, the proportion of people walking has decreased slightly and the proportion of people cycling has increased slightly.

Further news from the diabetes surveillance

In addition to the contextual factors, the following indicators have been added or updated for World Diabetes Day 2022:

• Children and adolescents

  • Incidence type 1 diabetes
  • Incidence type 2 diabetes
  • Prevalence type 1 diabetes

• Adults

  • Smoking
  • Physical inactivity
  • Poverty risk ratio
  • Treatment profiles type 2 diabetes
  • Age at diagnosis
  • Self-assessed quality of care
  • Depressive symptoms

Further information

All results for diabetes in children and adolescents can be found here.
All results for diabetes in adults can be found here.