Current practice of diabetes education in children and adolescents with type 1 diabetes in Germany and Austria: analysis based on the German/Austrian DPV database

Konrad, Katja; Vogel, Christian; Bollow, Esther; Fritsch, Maria; Lange, Karin; Bartus, B; Holl, Reinhard W.

doi:10.1111/pedi.12330

Cited by 20 publications

(16 citation statements)

References 27 publications

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“…Whereas outpatient/home care of newly diagnosed T1D is the rule in the US or in Australia, hospitalization at T1D onset is common in Germany [4]. Moreover, pediatric diabetes education programs or therapy adjustment are frequently offered as inpatient care in Germany [9,24].…”

Section: Discussionmentioning

confidence: 99%

“…However, in many countries with a high hospitalization rate for pediatric diabetes, most of inpatient cases are not due to T1D complications [1,7,8]. In Germany for instance, elective hospital admissions for T1D without complications, like management of newly diagnosed diabetes, diabetes education or insulin dose adjustment, represent most of the inpatient cases in pediatric diabetes [1,7,9]. Among other things, hospitalization can be necessary for the implementation of multimodal therapy concepts, for pre/postprandial and nocturnal glucose monitoring, or for the reimbursement of multidisciplinary education programs for the patients and their families.…”

Section: Introductionmentioning

confidence: 99%

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

Auzanneau

Rosenbauer

Icks

et al. 2019

Exp Clin Endocrinol Diabetes

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Introduction Regarding pediatric diabetes, hospital admission for acute complications of type 1 diabetes (T1D) has often been investigated, but little is known about other causes of hospitalization. This study aimed to explore the total burden of hospitalization in individuals with diabetes<20 years of age in Germany. Methods Using the German Diagnosis-Related Groups data for 2015, we examined the frequencies of hospitalization with diabetes (20 251 inpatient cases), stratified by diabetes type [T1D, type 2 diabetes (T2D), other specified diabetes types (T3D), and unclear diabetes], and without diabetes (1 269 631 inpatient cases). Using estimates of the population at risk with T1D, T2D, and without diabetes, we evaluated hospitalization rates (per patient-year) by Poisson regression. For T1D, T2D, and T3D, we investigated the most frequent diagnoses and the median length of stay. Most analyses were stratified by sex, age-group and east/west residence. Results Children and adolescents with diabetes had a 6 to 9 times higher hospitalization risk than peers without diabetes (hospitalization rate 0.09). The hospitalization rate was higher for T2D compared with T1D (0.84 vs. 0.53, P<0.001). In T2D, two-third of inpatient cases were not directly related to diabetes, and stay was shorter compared with T1D and T3D (3 vs. 4 and 5 days, respectively). In T1D, hospitalization was more frequent among girls than boys (0.58 vs. 0.49, P<0.001), and mostly due to “diabetes without complications” (65.7%). Hospitalization tended to be more frequent and longer in the youngest patients, and in those with east residence. Conclusion Hospitalization rate in pediatric diabetes in Germany remained high, especially for T2D patients, girls with T1D, and young children.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Auzanneau

Rosenbauer

Icks

et al. 2019

Exp Clin Endocrinol Diabetes

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“…CGMS includes real-time CGM and CGM with intermittent scanning, also called "flash glucose monitoring." Diabetes education was documented if a teaching session lasted for at least 45 min and if the patient and/or members of his or her family or other caregivers participated (21).…”

Section: Indicators Of Diabetes Carementioning

confidence: 99%

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

et al. 2018

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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.

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“…We found that patients with lower SES were admitted more frequently to the hospital and tended to stay longer, even though the rate of acute complications (severe hypoglycemia, DKA) was not higher than in patients with medium or higher SES. Although there was no difference among participants with different levels of SES in diabetes education attendance, more hospital admissions and longer hospital stays among patients with lower SES may reflect the fact that these patients receive individual coaching by the diabetes teams in addition to regular diabetes education . Furthermore, they may be admitted earlier to prevent acute complications.…”

Section: Discussionmentioning

confidence: 92%

The association between socio‐economic status and diabetes care and outcome in children with diabetes type 1 in Germany: The DIAS study (diabetes and social disparities)

et al. 2019

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Objective: To evaluate the association between socioeconomic status (SES) and diabetes outcomes in German children and adolescents.Methods: A total of 1829 subjects <18 years old with type 1 diabetes mellitus from 13 German diabetes centers were included from June 2013 until June 2014. Data were collected within the multicenter DPV (Diabetes Prospective Follow-up) registry. SES was measured with a composite index. Multivariable regression models were applied to analyze the association of SES and outcomes adjusted for age, sex, diabetes duration, and migration status.Results: Low SES was significantly associated with worse diabetes outcomes: higher hemoglobin A1C (HbA1c) (64.3 mmol/mol), lower proportion of insulin pump therapy (43.6%), fewer daily self-monitored blood glucose (SMBG) measurements (5.7), more inpatient days per patient-year (5.8) compared to patients with medium/high SES (HbA1c: 61.3 mmol/mol, P < 0.001/59.8 mmol/mol, P < 0.0001; proportion of pump therapy: 54.5%, P < 0.01/ 54.9%, P < 0.01; SMBG: 6.0, P < 0.01/ 6.1, P < 0.01; inpatient days: 4.5, P < 0.0001/3.4, P < 0.0001). The inclusion of migration status in the models resulted in only minor changes in the outcomes. Conclusion: Despite free health care, low SES is associated with unfavorable diabetes outcomes in Germany. The poorer diabetes outcomes of children with diabetes have been attributed to their migration status and may be partly explained by low SES. Both factors must become part of targeted diabetes care in children and adolescents with type 1 diabetes. K E Y W O R D S access to care, migration background, outcome, risk factors, socio-economic-status Kirsten Mönkemöller and Esther Müller-Godeffroy shared first authorship.

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Current practice of diabetes education in children and adolescents with type 1 diabetes in Germany and Austria: analysis based on the German/Austrian DPV database

Abstract: Training frequency was highest in younger patients and during the first year of diabetes. Acute complications resulted in more frequent diabetes training, indicating that currently many education sessions take place in consequence to these complications.

Cited by 20 publications

References 27 publications

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

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

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

The association between socio‐economic status and diabetes care and outcome in children with diabetes type 1 in Germany: The DIAS study (diabetes and social disparities)

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