Diagnosis, Therapy and Follow-up of Diabetes Mellitus in Children and Adolescents

Neu, Andreas; Bürger-Büsing, Jutta; Danne, Thomas; Dost, Axel; Holder, Martin; Holl, Reinhard W.; Holterhus, Paul‐Martin; Kapellen, Thomas; Karges, Beate; Kordonouri, Olga; Lange, Karin; Müller, Susanne; Raile, Klemens; Schweizer, Roland; Sengbusch, Simone von; Stachow, Rainer; Wagner, Verena; Wiegand, Susanna; Ziegler, Ralph

doi:10.1055/a-0869-0210

Cited by 21 publications

(26 citation statements)

References 496 publications

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“…Indication criteria are numerous, in particular: insufficient glycemic control with intensified conventional insulin therapy, severe hypoglycemia, dawn phenomenon, preschool age, pregnancy, needle phobia, or participation in competitive sports. 23 Application for reimbursement must contain an explanatory statement of the indication, a detailed documentation of the therapy and glycemic outcomes of the last 3 months, and certify that the patient will receive adequate pump education. Approval of the health insurance is first given for a probation period, and if glycemic values improves, final approval is given.…”

Section: Methodsmentioning

confidence: 99%

Heterogeneity of Access to Diabetes Technology Depending on Area Deprivation and Demographics Between 2016 and 2019 in Germany

Auzanneau

Rosenbauer

Maier

et al. 2021

J Diabetes Sci Technol

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Background: Despite increasing use of technology in type 1 diabetes, persistent ethnic and socio-economic disparities have been reported. We analyzed how the use of insulin pump therapy and continuous glucose monitoring (CGM) evolved over the years in Germany depending on demographics and area deprivation. Method: We investigated the use of insulin pump and CGM between 2016 and 2019 in 37,798 patients with type 1 diabetes aged < 26 years from the German Prospective Follow-up Registry (DPV). Associations with federal state, area-deprivation quintile (German Index of Multiple Deprivation 2010 on district level), gender, and migration background were investigated over time using multiple logistic regression. Results: Between 2016 and 2019, the regional distribution of insulin pump use did not change substantially and the association with area deprivation remained non-linear and statistically non-significant. The effect of area deprivation on CGM use decreased continuously and disappeared in 2019 (OR [95%-CI] Q1 vs Q5: 1.85 [1.63-2.10] in 2016; 0.97 [0.88-1.08] in 2019). The effect of migration background on the use of either technology decreased over the years but remained significant in 2019. Girls had constantly higher odds of using an insulin pump than boys (OR: 1.25 [1.18-1.31] in 2019), whereas no gender difference was identified for CGM use. Conclusions: Although disparities decreased in Germany, access to diabetes technology still depends on migration background in 2019, and gender differences in pump use persist. As technological advances are made, further research is needed to understand the reasons for these persistent disparities.

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Section: Methodsmentioning

confidence: 99%

Heterogeneity of Access to Diabetes Technology Depending on Area Deprivation and Demographics Between 2016 and 2019 in Germany

Auzanneau

Rosenbauer

Maier

et al. 2021

J Diabetes Sci Technol

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“…DKA typically occurs in patients with established diabetes mellitus who underwent insulin omission or inappropriate management of intercurrent illness or in patients with new-onset diabetes [2]. The biochemical criteria for ketoacidosis are: (1)pH < 7.3, (2) serum bicarbonate < 15 mmol/L, (3)plasma glucose concentration > 11 mmol/L, and (4)ketonuria and presence of ketones in serum [3]. Ketoacidosis is divided into three stages of severity based on pH and bicarbonate levels [4].…”

Section: Introductionmentioning

confidence: 99%

Hyperlactatemia associated with diabetic ketoacidosis in pediatric intensive care unit

Liu

Yan

2021

BMC Endocr Disord

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Background Children with diabetic ketoacidosis often have elevated lactate. In this study, we investigated the clinical variables associated with hyperlactatemia in children with diabetic ketoacidosis. Methods We designed a single-center retrospective descriptive study of children with diabetic ketoacidosis in a pediatric intensive care unit. Results Of the 107 patients with diabetic ketoacidosis included in the analysis, 61 developed hyperlactatemia. Multivariate logistic regression analysis showed that heart rate (p = 0.003),diastolic blood pressure (p = 0.001) and stage of severity (p = 0.042) were independently associated with the development of hyperlactatemia in diabetic ketoacidosis. We found that lactate level was not significantly associated with length of hospital stay (p = 0.115) or the length of time to diabetic ketoacidosis resolution (p = 0.143). Conclusions Children with diabetic ketoacidosis presenting with severer stage, elevated heart rate and higher diastolic blood pressure may be prone to hyperlactatemia. Hyperlactatemia was not associated with length of time to DKA resolution and length of hospital stay.

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“…The metabolic control status of the children with T1DM was evaluated according to the mean hemoglobin A1c (HbA1c) values of the recent 1 year (mean of the last four visits) as good (HbA1c < 7.0%), moderate (HbA1c, 7.0%‐8.9%), and poor (HbA1c ≥ 9%) control 16,17 …”

Section: Methodsmentioning

confidence: 99%

Assessment of pulmonary function by impulse oscillometry and spirometry in children with type 1 diabetes mellitus

Anık

Uysal

2020

Pediatric Pulmonology

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Aim To assess the lung functions with impulse oscillometry (IOS) and spirometry in children with type 1 diabetes mellitus (T1DM). Methods Fifty‐one children with T1DM, and sex‐ and age‐matched 53 healthy control (HC) subjects were included in this study. Demographic, clinical, and laboratory characteristics of the subjects were recorded and their pulmonary functions were analyzed by IOS and spirometry. Results In IOS, zR5, zR10, and zR20 levels were higher in children with T1DM compared with HCs (P = .019, P = .017, and P = .002, respectively). In spirometry, zFEF75 and zFEF25‐75 were lower in children with T1DM compared with HCs (P = .025, P = .001, respectively). In IOS, zR5‐20 (P = .008, P = .005, respectively) and zAX (P = .013, P = .009, respectively) were significantly lower in good‐controlled group compared with moderate‐ and poor‐controlled group. In spirometry, zFEF25‐75 was significantly higher in good‐controlled group compared with moderate‐ and poor‐controlled group (P = .005, P = .009, respectively). HbA1c was positively correlated with zR5‐20 value (r = .339; P = .017) in male children with T1DM. The duration of the disease was positively correlated with zR5‐20 (r = .290; P = .043) and zFres (r = .358; P = .010). According to the receiver operating characteristic curve analysis to estimate optimal cut‐offs to discriminate good control level of T1DM (HbA1c < 7%), a zR5‐20 ≤ 2.28 demonstrated a 75.0% sensitivity and 82.9% specificity, with an area under the curve of 0.805 ([confidence interval, 0.615‐0.995]; P = .007). Conclusions This study showed subclinical impairment of lung functions which is associated with disease duration and the degree of metabolic control in children with T1DM.

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Diagnosis, Therapy and Follow-up of Diabetes Mellitus in Children and Adolescents

Cited by 21 publications

References 496 publications

Heterogeneity of Access to Diabetes Technology Depending on Area Deprivation and Demographics Between 2016 and 2019 in Germany

Heterogeneity of Access to Diabetes Technology Depending on Area Deprivation and Demographics Between 2016 and 2019 in Germany

Hyperlactatemia associated with diabetic ketoacidosis in pediatric intensive care unit

Assessment of pulmonary function by impulse oscillometry and spirometry in children with type 1 diabetes mellitus

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