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-1018-8963

Cited by 44 publications

(60 citation statements)

References 45 publications

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“…Our analysis showed a significantly less frequent use of CSII in the least deprived districts (Q1) compared with others (Q2-Q5). In Germany, CSII is reimbursed on a case-by-case basis, if certain medical criteria have been met (leading to approval by the health insurance company), for instance, if intensified conventional insulin therapy is not sufficient to achieve goals for glycemic control (14). We found the lowest HbA 1c levels in the least deprived districts (Q1) where pump use was also less frequent.…”

Section: Discussionmentioning

confidence: 77%

“…Nevertheless, regional socioeconomic disparities may be a major determinant of the use of insulin pump therapy (continuous subcutaneous insulin infusion [CSII]), continuous glucose monitoring systems (CGMS), and insulin analogs. In Germany, CSII is reimbursed by the statutory health insurance (covering ;90% of the population) if poor glycemic control persists despite intensified conventional insulin treatment (14). Patients and diabetologists have to apply to the health insurance company for reimbursement by providing comprehensive documentation of the blood glucose levels and insulin therapy over the last 3 months.…”

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confidence: 99%

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Area Deprivation and Regional Disparities in Treatment and Outcome Quality of 29,284 Pediatric Patients With Type 1 Diabetes in Germany: A Cross-sectional Multicenter DPV Analysis

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 77%

mentioning

confidence: 99%

Area Deprivation and Regional Disparities in Treatment and Outcome Quality of 29,284 Pediatric Patients With Type 1 Diabetes in Germany: A Cross-sectional Multicenter DPV Analysis

et al. 2018

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“…Inpatient rehabilitation is a well-established additive option in the therapeutic concept for children and adolescents with T1D in Germany. Inpatient rehabilitation is not only indicated in case of insufficient metabolic control, recurrent severe hypoglycemia or ketoacidosis, comorbidities or organ complications, but also to enable the composition of age-appropriate education groups [3,4,7].…”

Section: Discussionmentioning

confidence: 99%

“…There is some evidence that spending a long time (generally four, sometimes six weeks) with other affected children of the same age and sharing experiences can improve self-management attitudes [6]. Furthermore, inpatient rehabilitation can be proposed for age appropriate initial education following diabetes onset, or for training of insulin pump therapy, when such education is not available in the hometown [4,7].…”

Section: Introductionmentioning

confidence: 99%

Inpatient Rehabilitation for Children and Adolescents With Diabetes in Germany Between 2006 and 2013

Auzanneau

Bohn

Schiel³

et al. 2018

Exp Clin Endocrinol Diabetes

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Introduction In Germany, inpatient rehabilitation is a well-established additive option in the therapeutic concept for children and adolescents with diabetes. However, its contribution in pediatric diabetes care is not known exactly. Our objective was to analyze inpatient rehabilitation in pediatric diabetes over eight years in Germany. Methods We requested secondary data from the German Statutory Pension Insurance Scheme to evaluate all completed inpatient rehabilitations for children and adolescents with diabetes (ICD-code E10-14) reimbursed by this institution between 2006 and 2013. For each type of diabetes, we analyzed the distribution of admissions by year, age-group, sex, nationality, and other documented diagnoses. All analyses were conducted via remote computing with IBM SPSS Version 24. Results Between 2006 and 2013, 5,403 admissions to inpatient rehabilitation for 4,746 children and adolescents with diabetes were documented. For type 1 diabetes (T1D; 88.5% of admissions), the number of yearly admissions increased from 458 in 2006 to 688 in 2013 (p=0.013), especially for age-group>5-10. The increase for type 2 diabetes (T2D) was not significant. Admissions were more frequent for girls (53.6%, p≤0.001), age>10-15 years (42.8%, p=0.001), and German nationality (98.5%). Obesity (T1D: 11.1%; T2D: 87.9%) and mental disorders (T1D: 11.6%; T2D: 27.4%) were the most frequent documented diagnoses in addition to diabetes. Conclusion This study provides a comprehensive overview of inpatient rehabilitation for children and adolescents with diabetes over many years in Germany. Until 2013, inpatient rehabilitation remained important in pediatric diabetes care, especially for children with mental disorders or obesity.

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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 44 publications

References 45 publications

Area Deprivation and Regional Disparities in Treatment and Outcome Quality of 29,284 Pediatric Patients With Type 1 Diabetes in Germany: A Cross-sectional Multicenter DPV Analysis

Area Deprivation and Regional Disparities in Treatment and Outcome Quality of 29,284 Pediatric Patients With Type 1 Diabetes in Germany: A Cross-sectional Multicenter DPV Analysis

Inpatient Rehabilitation for Children and Adolescents With Diabetes in Germany Between 2006 and 2013

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

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