OBJECTIVETo compare clinical characteristics and outcome of type 1 diabetes mellitus (T1DM) between patients with and without a clinically recognized eating disorder (ED). RESEARCH DESIGN AND METHODSA total of 52,215 T1DM patients aged 8 to <30 years from the prospective diabetes data acquisition system DPV were analyzed. A total of 467 patients had an additional diagnosis of ED according to DSM-IV criteria (anorexia nervosa [AN], n = 141 [female: 94.3%]; bulimia nervosa [BN], n = 62 [90.3%]; and EDs not otherwise specified, including binge-eating disorder [EDNOS], n = 264 [74.2%]). Groups were compared using multivariable regression. Cox proportional hazard ratios were calculated for the association between ED and retinopathy. RESULTSAfter adjustment for age, sex, and duration of diabetes, patients with ED revealed higher HbA 1c (no ED vs. AN, BN, or EDNOS, respectively: 8.29 6 0.01% [67.1 6 0.1 mmol/mol] vs. 8.61 6 0.15% [70.6 6 1.6 mmol/mol], 9.11 6 0.23% [76.1 6 2.5 mmol/mol], or 9.00 6 0.11% [74.9 6 1.2 mmol/mol]) and a higher rate of pathological insulin injection sites (48.4 vs. 64.3, 64.1, or 62.1%). Furthermore, ketoacidosis (5.7 6 0.1 vs. 12.1 6 2.1, 18.0 6 4.1, or 12.9 6 1.6 events per 100 person-years) and hospitalization (54.9 6 0.3 vs. 89.3 6 6.0, 132.0 6 12.7, or 91.0 6 4.4 per 100 person-years) were more common, and duration of hospital stay was longer (4.81 6 0.01 vs. 11.31 6 0.21, 18.05 6 0.48, or 8.44 6 0.13 days per year). All P values were <0.05. Patients with BN and EDNOS had a 2.5-fold (95% CI 1.3-4.8) and a 1.4-fold (0.8-2.3) higher risk for retinopathy, whereas AN patients had no increased risk (0.9 [95% CI 0.4-2.3]). CONCLUSIONSDiabetes health care professionals should be aware of comorbid EDs in pediatric/ young-adult T1DM patients. An ED diagnosis is associated with worse metabolic control and higher rates of diabetes complications.
Additional metformin therapy in T1DM is primarily used in obese females. Additional therapy with metformin was associated with minor benefits.
Aims To analyse the association between coeliac disease (CD) and depression in children, adolescents, and young adults with type 1 diabetes (T1D). Methods We included 79,067 T1D patients aged 6–20 years, with at least six months of diabetes duration, and treatment data between 1995 and 2019 were documented in the diabetes patient follow-up registry. We categorized patients into four groups: T1D only (n = 73,699), T1 + CD (n = 3379), T1D + depression (n = 1877), or T1D + CD + depression (n = 112). Results CD and depression were significantly associated (adjusted OR: 1.25 [1.03–1.53]). Females were more frequent in both the depression and the CD group compared with the T1D only group. Insulin pumps were used more frequently in T1D + CD and T1D + depression compared with T1D only (both p < .001). HbA1c was higher in T1D + depression (9.0% [8.9–9.0]), T1D + CD + depression (8.9% [8.6–9.2]), both compared with T1D only (8.2% [8.2–8.2], all p < .001). We found comorbid autism, attention deficit hyperactivity disorder, anxiety, schizophrenia, and eating disorders more frequently in the T1D + CD + depression group compared with T1D only (all p < .001). Conclusions CD and depression are associated in young T1D patients. The double load of T1D and CD may lead to an increased risk for depression. Depression was associated with additional psychological and neurological comorbidities. Aside from imperative CD screening after T1D diagnosis and regular intervals, depression screening might be helpful in routine care, especially in patients with diagnosed CD.
Zusammenfassung Hintergrund Während der Pandemie zeigte sich ein Rückgang durchgeführter Kinderrehabilitationen um mehr als 30% im Pandemiejahr 2020. Die Daten stammen vom Rentenversicherungsträger, der aber nicht alleine Träger für Kinderrehabilitationen ist. Die DPV-Datenbank bietet die Möglichkeit alle Rehabilitanden mit Diabetes unabhängig vom Träger in den Vor-Pandemiejahren und den Jahren 2020/21 zu analysieren. Methoden Vergleich der stationären Aufnahmen in 11 Rehakliniken in den Jahren 2019 (vor Pandemie) mit 2020/21. Monatliche Analyse von Zahl der Aufnahmen, Liegedauer, HbA1c- und BMI-Entwicklung. Ost-West-Vergleich sowie Subanalyse von Rehabilitanden unter und über 12 Jahren. Ergebnisse Im Jahr 2019 wurden 2237 Kinder und Jugendliche mit Typ 1 Diabetes rehabilitiert, in 2020 Reduktion auf 1455 (35%) und keine Erholung in 2021 (n=1447). Ein besonders starker Einbruch der aufgenommenen Kinder und Jugendlichen zeigte sich im April und Mai 2020 während des 1. Lockdowns. Auch bei der Liegedauer zeigte sich dieser Einbruch in der Zeit des ersten Lockdowns. Im Ost-West-Vergleich ist die Zahl der Rehabilitanden im Osten stabiler geblieben. Der HbA1c zeigte während der Monate des ersten Lockdowns einen signifikanten Anstieg (April 2019: 8.19% (7.94, 8.44); April 2020: 8.68% (8.25, 9.11); April 2021 7.94% (7.63, 8.24)). In der altersstratifizierten Analyse zeigte sich ein Anstieg auf höherem Niveau des HbA1c in den Monaten des ersten Lockdowns bei den Jugendlichen in Vergleich zu den Kindern unter 12 Jahren. Der BMI-SDS war in 2019 bei 0.29 (0.24¸ 0.33), stieg im Jahr 2020 auf 0.35 (0.29; 0.41) und weiter auf 0.41 (0.35; 0.46) in 2021. Schlussfolgerung Es kam zu einem deutlichen Abfall der stationären Rehabilitationen während der Corona-Pandemie und zu keiner Erholung im 2. Pandemiejahr.
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