Impact of Maternal Country of Birth on Type-1-Diabetes Therapy and Outcome in 27,643 Children and Adolescents from the DPV Registry

Abstract

ObjectiveTo study the impact of maternal country of birth on type-1-diabetes (T1D) therapy and outcome.Study Design and Methods27,643 T1D patients aged ≤20 years with documented maternal country of birth from the multicenter German/Austrian diabetes patient registry (DPV) were analyzed. Patients were categorized based on their mother’s origin: Germany/Austria (reference), Turkey, Southern Europe, and Eastern Europe. To compare BMI standard deviation score (BMI-SDS), diabetes therapy and outcome between groups, multivariable regression was applied with adjustments for age, sex and duration of diabetes. Based on observed marginal frequencies, adjusted estimates were calculated. Linear regression was used for continuous data, logistic regression for binary data and Poisson regression for count data. All statistical analyses were performed using SAS 9.4. Significance was set at a two-tailed p<0.05.Results83.3% of patients were offspring of native mothers. A Turkish, Southern or Eastern European background was documented in 2.4%, 1.7% and 4.3% of individuals. After demographic adjustment, patients with migration background had a higher mean BMI-SDS (Turkey, Southern Europe or Eastern Europe vs. Germany/Austria: 0.58±0.03, 0.40±0.04, or 0.37±0.02 vs. 0.31±0.01; ±SE) and a lower use of insulin pumps (26.8%, 27.9%, or 32.6% vs. 37.9%) compared to offspring of native mothers. Mean HbA1c was worst in individuals of Turkish mothers (Turkey vs. Germany/Austria: 69.7±0.7 vs. 66.6±0.1 mmol/mol; ±SE). Patients of Eastern European descent had an increased rate of severe hypoglycemia (22.09±0.13 vs. 16.13±0.02 events per 100 patient-years) and ketoacidosis was more prevalent in offspring of Turkish or Southern European mothers (7.50±0.10, or 7.13±0.11 vs. 6.54±0.02 events per 100 patient-years). Patients of Turkish descent were more often hospitalized (57.2±2.7 vs. 48.5±0.4 per 100 patient-years). All differences were significant.ConclusionThe differences in diabetes therapy and outcome among patients with distinct migration background suggest that specific challenges have to be considered in clinical care.

Incidence of severe hypoglycemia and possible associated factors in pediatric patients with type 1 diabetes mellitus in the real‐life, post‐DCCT setting: a systematic review

“…The trend towards a reduced rate of SH after publication of the results of the DCCT is in agreement with other recent convincing studies and reviews . For example, in the Epidemiology of Diabetes Interventions and Complications (EDIC) study—an approximately 30‐year follow‐up of DCCT patients—the incidence of SH decreased from 62.0 to 40.8 per 100 PY in the initial intensive therapy group .…”

A systematic review of non‐genetic predictors and genetic factors of glycated haemoglobin in type 1 diabetes one year after diagnosis

“…Ethnicity and migration background were associated with HbA1c level in Europe, America, and Israel . In the US, HbA1c level was found to be higher in T1D patients belonging to ethnic minority groups, with a mean HbA1c level difference varying between 0.9% (9.8 mmol/mol) and 1.5% (16.4 mmol/mol) in African‐Americans compared with Caucasian‐Americans .…”

“…The sample size range is 70 to 30 708 patients with a median sample size of 210 T1D patients. Thirty‐two studies were performed in several European countries, 31 in USA, one in Canada, three in Israel, and the rest in other countries (one in Japan, one in New‐Zealand, three in Turkey, one in Australia, and three are multinational). Most studies (54 studies) were performed on T1D children (median of mean age reported in articles 12.5 [range: 4.1‐17.7]), 22 included both children and young adults (median of mean age of 14.8 [range: 10.1‐21.6]), and one included only young adults (mean age of 19.4 ± 0.9 [range: 18‐21]).…”

“…In the event of duplicate studies, only one was considered. Some studies investigated independent factors on the same large cohort and so have been included in the selection: the Danish registry of childhood and adolescent diabetes (DanDiabKids); the Diabetes‐Patienten‐Verlaufsdokumentation or diabetes‐patient‐documentation (DPV Germany‐Austria); the T1D exchange clinic network (T1DX); the Swedish childhood diabetes registry (SweDiabKids) As no review exists on the genetic factors of HbA1c in T1D patients and due to the low number of studies, a similar search strategy was used, with the additional following inclusion/exclusion criteria: (1) the term “genetic” listed in the key words; (2) no date limit for publications; and (3) a less restrictive age limit (childhood and early adulthood).…”

ISPAD Clinical Practice Consensus Guidelines 2018: The delivery of ambulatory diabetes care to children and adolescents with diabetes

“…With the urbanization movement in emerging countries, many children and their parents become dislocated as newcomers to cities, while leaving their home along with extended family members. Studies in different countries demonstrate that children with diabetes from new migrant families have poorer glycemic control, higher BMI, lower utilization of technologies and higher frequency of diabetes‐related hospitalization than the general endemic population suggesting that specific psychosocial, cultural, and biological challenges have to be considered in the clinical care of these families …”