Evidence for a persistent, major excess in all cause admissions to hospital in children with type-1 diabetes: results from a large Welsh national matched community cohort study

Abstract

ObjectivesTo estimate the excess in admissions associated with type1 diabetes in childhood.DesignMatched-cohort study using anonymously linked hospital admission data.SettingBrecon Group Register of new cases of childhood diabetes in Wales linked to hospital admissions data within the Secure Anonymised Information Linkage Databank.Population1577 Welsh children (aged between 0 and 15 years) from the Brecon Group Register with newly-diagnosed type-1 diabetes between 1999–2009 and 7800 population controls matched on age, sex, county, and deprivation, randomly selected from the local population.Main outcome measuresDifference in all-cause hospital admission rates, 30-days post-diagnosis until 31 May 2012, between participants and controls.ResultsChildren with type-1 diabetes were followed up for a total of 12 102 person years and were at 480% (incidence rate ratios, IRR 5.789, (95% CI 5.34 to 6.723), p<0.0001) increased risk of hospital admission in comparison to matched controls. The highest absolute excess of admission was in the age group of 0–5 years, with a 15.4% (IRR 0.846, (95% CI 0.744 to 0.965), p=0.0061) reduction in hospital admissions for every 5-year increase in age at diagnosis. A trend of increasing admission rates in lower socioeconomic status groups was also observed, but there was no evidence of a differential rate of admissions between men and women when adjusted for background risk. Those receiving outpatient care at large centres had a 16.1% (IRR 0.839, (95% CI 0.709 to 0.990), p=0.0189) reduction in hospital admissions compared with those treated at small centres.ConclusionsThere is a large excess of hospital admissions in paediatric patients with type-1 diabetes. Rates are highest in the youngest children with low socioeconomic status. Factors influencing higher admission rates in smaller centres (eg, “out of hours resources”) need to be explored with the aim of targeting modifiable influences on admission rates.

Hospital admission in children and adolescents with or without type 1 diabetes from Germany: An analysis of statutory health insurance data on 12 million subjects

“…The lowest OR was found in young adults between >15 and ≤19 years (OR 4.0). A higher hospital admission risk in younger children was also reported in other studies . However, an earlier published cross‐sectional study from Germany indicated the highest hospital rate ratios in children during puberty (10 to <15 years of age) .…”

“…Although a higher hospital admission rate in pediatric subjects with T1D compared to that without T1D was also reported in other studies, the OR in our study population were considerably higher . A study from the German/Austrian DPV registry reported a 3‐fold higher admission rate ratio compared to the general pediatric population without T1D .…”

Correlation Among Hypoglycemia, Glycemic Variability, and C-Peptide Preservation After Alefacept Therapy in Patients with Type 1 Diabetes Mellitus: Analysis of Data from the Immune Tolerance Network T1DAL Trial

“…This is a particular problem in children and adolescents, in whom excess rates of hospitalization are approximately 5-fold those seen in the nondiabetic population and up to 40% of the excess hospitalization is due to hypoglycemia. 4–7 We used the standard deviations (SDs) in the glucometer readings as a surrogate for glycemic variability and found an inverse correlation between SD values and the MMTT-stimulated 4-hour C-peptide AUC in both the alefacept and placebo groups. This was supported by a similar correlation between the highest glucometer readings and the 4-hour C-peptide AUC, and, albeit a weaker correlation, between the lowest glucometer readings and the 4-hour C-peptide AUC.…”

“…Hospitalization rates in younger patients with T1D are substantially higher than in the general population, most frequently because of inadequate glycemic control with life-threatening episodes of hyper- or hypoglycemia. 4–7 T1D-induced glycemic variability, particularly repeated episodes of major hypoglycemia, has been linked to abnormalities in brain development, including cognitive dysfunction, which may extend into adulthood. 8–11 Hypoglycemic episodes have been linked to cardiac abnormalities, including ventricular arrhythmias, which may be a contributing factor to the so-called “dead-in-bed” syndrome in younger T1D patients.…”

Presentation to primary care during the prodrome of type 1 diabetes in childhood: A case‐control study using record data linkage

“…By analyzing data from 12 months prior to diagnosis, we have identified a longer prodrome of symptoms (up to 6 months) than is usually assumed. Our data from the Brecon Group Register is a robust, country‐wide hospital recorded dataset (98% complete coverage of all known childhood‐onset cases), and our prospective collection of this diagnostic dataset likely provides an accurate date of diagnosis, as it is recorded by diabetes healthcare professionals at the time of diagnosis. Another strength of our study is that it uses prospectively collected primary care data and therefore the results will be less prone to the bias and inaccuracies of recall which influence many other studies on this topic …”