Lower Frequency of Insulin Pump Treatment in Children and Adolescents of Turkish Background with Type 1 Diabetes: Analysis of 21,497 Patients in Germany

Abstract

Aim: This study investigated insulin pump therapy in pediatric patients with type 1 diabetes and Turkish origin compared with those without migration background in Germany. Subjects and Methods: Using a nationwide documentation program, we estimated the prevalence of insulin pump therapy in patients < 20 years of age with Turkish origin and those without migration background. Logistic regression was used to adjust for age, sex, diabetes duration, body mass index SD score (BMI-SDS), glycated hemoglobin, number of outpatient visits, number of daily blood glucose self-measurements, and area-based socioeconomic conditions. Results: In 1,695 pediatric type 1 diabetes patients with Turkish background and 19,802 patients without migration background (respectively: 51.2% and 53.0% boys; mean age, 12.4 -4.1 and 12.6 -4.2 years; mean diabetes duration, 4.7 -3.9 and 5.3 -4.0 years), fully adjusted prevalences of insulin pump therapy were 18.5% and 30.9%, respectively (odds ratio 0.51, 95% confidence interval 0.43-0.60, P < 0.001). Age, sex, BMI-SDS, outpatient visits, and blood glucose self-control were significantly associated with the prevalence of insulin pump therapy but did not alter the difference substantially. Conclusions: The prevalence of insulin pump therapy is roughly half among pediatric diabetes patients with Turkish background compared with those without migration background. Several covariates could not explain this difference. Individual characteristics or access barriers within the healthcare system may play a role. Further research is needed.

Contrasting the clinical care and outcomes of 2,622 children with type 1 diabetes less than 6 years of age in the United States T1D Exchange and German/Austrian DPV registries

“…However, within the T1DX, higher household income, higher parental education level and having private insurance have been shown to predict better HbA 1c levels in children under 18 years of age [18]. In the DPV registry, children of Turkish background were half as likely to use pumps as those without a migration history even after adjustment for factors that differed by migration history (age, sex, BMI standard deviation score (BMI-SDS), outpatient visit and self-control of blood glucose) [19].…”

ISPAD Clinical Practice Consensus Guidelines 2018: The delivery of ambulatory diabetes care to children and adolescents with diabetes

“…Disparities in care and outcomes exist-less intensive treatments, poorer glucose control, and increased rates of DKA are reported in children from less advantaged homes as well as from countries with fewer resources. [19][20][21][22][23][24] Health care staff should strive to determine each young person's and their caregiver's status regarding knowledge, perceived glycemic control, and risk perception, as well as perceived benefits and costs of health behaviors. The diabetes team is encouraged to engage with children as they mature, using developmentally appropriate educational tools, while recognizing that the child must be treated in the context of their existing psychosocial environment.…”

The Benefits, Limitations, and Cost-Effectiveness of Advanced Technologies in the Management of Patients With Diabetes Mellitus

“…In Germany, for example, pediatric patients of Turkish origin are half as likely as native Germans to have an insulin pump prescribed which is independent of other socioeconomic factors. 32 …”