Area Deprivation and Regional Disparities in Treatment and Outcome Quality of 29,284 Pediatric Patients With Type 1 Diabetes in Germany: A Cross-sectional Multicenter DPV Analysis

Abstract

This study analyzed whether area deprivation is associated with disparities in health care of pediatric type 1 diabetes in Germany. RESEARCH DESIGN AND METHODS We selected patients <20 years of age with type 1 diabetes and German residence documented in the "diabetes patient follow-up" (Diabetes-Patienten-Verlaufsdokumentation [DPV]) registry for 2015/2016. Area deprivation was assessed by quintiles of the German Index of Multiple Deprivation (GIMD 2010) at the district level and was assigned to patients. To investigate associations between GIMD 2010 and indicators of diabetes care, we used multivariable regression models (linear, logistic, and Poisson) adjusting for sex, age, migration background, diabetes duration, and German federal state. RESULTS We analyzed data from 29,284 patients. From the least to the most deprived quintile, use of continuous glucose monitoring systems (CGMS) decreased from 6.3 to 3.4% and use of long-acting insulin analogs from 80.8 to 64.3%, whereas use of rapid-acting insulin analogs increased from 74.7 to 79.0%; average HbA 1c increased from 7.84 to 8.07% (62 to 65 mmol/mol), and the prevalence of overweight from 11.8 to 15.5%, but the rate of severe hypoglycemia decreased from 12.1 to 6.9 events/100 patient-years. Associations with other parameters showed a more complex pattern (use of continuous subcutaneous insulin infusion [CSII]) or were not significant. CONCLUSIONS Area deprivation was associated not only with key outcomes in pediatric type 1 diabetes but also with treatment modalities. Our results show, in particular, that the access to CGMS and CSII could be improved in the most deprived regions in Germany.

Multicentre analysis of hyperglycaemic hyperosmolar state and diabetic ketoacidosis in type 1 and type 2 diabetes

“…Frequency of pump therapy was lower in patients with DKA. Previous studies found that migration background and lower socioeconomic status (SES) are associated with lower frequency of insulin pump therapy, higher BMI, worse metabolic control, and DKA [26][27][28].…”

Patients with coronary artery disease after acute myocardial infarction: effects of continuous enrollment in a structured Disease Management Program on adherence to guideline-recommended medication, health care expenditures, and survival

“…Propensity score matching was conducted to elicit a control group of DMP participants who matched characteristics of DMP CAD participants with regard to the class variables "sex", "smoking status", "obesity", "angina pectoris", "arterial occlusive disease", "dyslipidemia", "congestive heart failure", "arterial hypertonia", "New York Heart Association (NYHA) state", enrollment in "DMP COPD", and "DMP type 2 diabetes", "stent in the year before AMI". Further, the continuous variables "age", "German Index of Multiple Deprivation 2010 (GIMD 2010)" on district level [22], "HMG compensations per day", and "length of index hospitalization" at baseline. A 1:1 matching was conducted on the logit of the propensity score using calipers of width equal to 0.2 of the standard deviation of the logit of the propensity score [23].…”

Hospitalization in Pediatric Diabetes: A Nationwide Analysis of all Admission Causes for Germany in 2015

“…Another explanation could be the higher proportion of families with low socioeconomic status in the eastern part of the country [30]; a recent study showed that children and adolescents from families with low soci-oeconomic status in Germany are hospitalized more frequently and longer than other children [31]. Moreover, there is some evidence that a higher regional deprivation in the eastern part of Germany leads to worse diabetes outcomes, and also to increased hospital admissions [10,32].…”

“…The aim of this study was to gain a comprehensive overview of hospitalization (frequency, causes, length of stay) in children and adolescents with diabetes in Germany using the nationwide DRG data. Taking into account a recent report indicating significant regional disparities in pediatric diabetes care in Germany, in particular between the western and the eastern part of the country [10], we additionally compared hospitalizations between east and west residence.…”