Hospitalization Among Diabetic Children and Adolescents and the General Population in Germany

Abstract

OBJECTIVE -To compare hospitalization in a multicenter-based cohort of diabetic children and adolescents (aged 1-19 years) in Germany with that of the general population.RESEARCH DESIGN AND METHODS -Based on standardized documentation, hospital stays after manifestation were ascertained in diabetic subjects 1-19 years of age in 1997. Hospitalization data in the general German population were derived from official statistics. Incidence rates and numbers of hospital days were estimated. Ratios of hospitalization incidences and numbers of hospital days between the diabetic and the general population were calculated. Costs for hospital care in the German diabetic population in 1997 were determined.RESULTS -A total of 5,874 patients came from 61 pediatric centers (52% male, age [mean Ϯ SD] 12.2 Ϯ 4.3 years, diabetes duration 4.6 Ϯ 4.4 years). Hospitalization incidence rates and hospital days per person-year (95% CI) were 0.27 (0.25-0.29) and 1.80 (1.75-1.84) in the diabetic population and 0.0948 (0.0946 -0.0949) and 0.6416 (0.6412-0.6420) in the general population. The standardized ratio of hospital incidences was 3.1 (2.9 -3.2), and the ratio of numbers of hospital days was 2.8 (2.7-2.9). Costs for hospital care after manifestation were estimated to be $506 (U.S. dollars) per person-year and $12.4 million in the whole German diabetic population aged 1-19 years in 1997; including hospital stays at diabetes onset, total annual costs were $24 million ($970 per person-year).CONCLUSIONS -Diabetic children and adolescents in Germany had an approximately three times higher hospitalization risk and three times more hospital days than the age-matched general population. Including hospitalization at diabetes onset, the annual costs of hospital care for the German diabetic population aged 1-19 years amounted to ϳ1% of all costs for hospital care in this age-group. Thus, costs were largely overproportional (diabetes prevalence 0.1%).

Hospitalization among diabetic children and adolescents and non-diabetic control subjects: a prospective population-based study

“…Because hospitalization is, however, a striking event for families, underreporting due to recall bias is not likely. Furthermore, hospital incidences in our study were in line with a clin-ic-based study in diabetic paediatric patients in Germany in 1997 [21].…”

“…The hospitalization incidence in diabetic subjects in the present study was similar to those found in centre-based studies using clinical documentation [21,22], as well as those reported in Great Britain in the first course after onset [14]. However, it was much higher than those from the United States [17,16].…”

“…In two recent clinic-based studies comparing diabetic subjects under 20 years of age in Germany with the general population, the hospital risk ratios were similiar to those observed in the present study, whereas the ratios of hospital days per person-year were lower (3.0 and 3.8) [21,22]. This can be explained in part by longer hospital stays in the first course of treatment after diabetes onset [14].…”

Increased hospitalization with longer distance from treatment centre in diabetic paediatric patients in Germany

“…This association cannot be explained by age, sex, diabetes duration, metabolic control or and treatment centre. This clinic-based study cohort included more than one third of all German diabetic subjects under 20 years of age and can be assumed to be representative for population-based diabetic populations in Germany with regard to age, sex and clinical outcomes [7,8]. The results of our study therefore support the concept of`patient-near' care and indicate that the distance between patients' residence and treatment centre should be considered when planning structures of diabetes care.…”

Behandlung der Adipositas bei Diabetes mellitus

“…Lebensjahr ist er die häufigste Diabetesform. Die Prävalenz des Diabetes Typ 2 steigt bis zum Alter von 80 Jahren deutlich an (von 2% bei 40-Jährigen bis zu über 20% in höheren Lebensaltern)[10].Die Ätiologie des Diabetes mellitus Typ 2 stellt ein komplexes Geschehen dar, bei dem sowohl genetische wie auch Umwelteinflüsse eine Rolle spielen. So werden Konkordanzraten bei eineiigen Zwillingen von bis zu 90% beschrieben[13], wobei die genetische Grundlage noch nicht genau bekannt ist.…”