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.
Background: BMI fluctuations during puberty are common. Data on individual change in BMI from childhood to young adulthood are limited in youth with type 1 diabetes.
Background: Chorangiomas are villous capillary tumors of the placenta with high impact on neonatal morbidity and mortality. Cardiac complications have occasionally been reported. Objective: To elucidate clinical features, diagnosis and treatment of cardiac failure caused by chorangiomas. Method:We report a case of a newborn, in whom massive chorangiomas were associated with severe cardiac failure, anemia, and thrombocytopenia. Results: Chorangiosis was not diagnosed prenatally. The pre-existing cardiac failure of the infant deteriorated soon after birth. Despite the severe stage, cardiac failure was reversible with intensive medical treatment including phosphodiesterase inhibitor. Complete recovery with no signs of cardiomyopathy was confirmed at the age of 5 months. Conclusions: Severe cardiac failure in the neonate can be caused by chorangiosis. The time of diagnosis and treatment seems to be critical for the outcome of the infant. Prenatal treatment interventions should be considered.
Obesity in youth with type 1 diabetes (T1D) has emerged as a challenge in care. Data from the Australasian Diabetes Data Network (ADDN), Diabetes Prospective Follow-up (DPV) in Austria and Germany, and T1D Exchange (T1DX) registry in the U.S. were compared to assess international differences in BMI z-score trajectories in youth with T1D. Longitudinal data from 11,513 participants between ages 8-17 years with T1D duration ≥1 year. and ≥5 aggregated body mass index (BMI) values (ADDN: N=1073, 46% female, mean HbA1c 8.3%; DPV: N=8722, 46% female, mean HbA1c 7.8%; T1DX: N=1718, 45% female, mean HbA1c 8.6%) were analyzed. Participants diagnosed with celiac and/or thyroid disease were excluded. Latent class growth modeling by Nagin was used to identify subgroups following similar BMI z-score trajectories. Five distinct trajectories were identified in ADDN and T1DX participants, and six in DPV (Figure). In all registries most participants in ADDN and T1DX maintained weight status over time. However, obese (BMI z-score ≥2) participants from ADDN achieved weight loss over time, compared to obese participants in T1DX, whose BMI SD increased during the teen years. In DPV, there were trajectories indicating dramatic weight gain/loss during puberty. Further analysis by sex and minority status will help to understand the within-registry and between-registry variation and may help target clinical interventions to achieve healthy weight in youth with T1D.
Disclosure
M. Wu: None. H. Phelan: None. A. Schwandt: None. N.C. Foster: None. J. Couper: None. C. Steigleder-Schweiger: None. S.M. Willi: Advisory Panel; Self; Boehringer Ingelheim GmbH. Other Relationship; Self; Caladrius Biosciences, Inc.. Consultant; Self; GlaxoSmithKline plc., JAEB Center For Health Research. T. Jones: None. P. Kroschwald: None. D.M. Maahs: Advisory Panel; Self; Insulet Corporation. Consultant; Self; Abbott. Research Support; Self; Medtronic, Bigfoot Biomedical, Dexcom, Inc., Insulet Corporation, Roche Diabetes Care Health and Digital Solutions. N. Prinz: None. M.E. Craig: None.
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