Abstract
BackgroundTo investigate changes in diabetes treatment over the last two decades in three age-groups of children and adolescents with type 1 diabetes (T1D) from Germany and Austria.Methods63,967 subjects (<18yr) with T1D documented between 1995 and 2014 from the DPV-database were included and stratified according to age (0.5-<6, 6-<12, 12-<18yr). Regression models were applied for insulin regimens (<3 and ≥4 injection time points/day, or continuous subcutaneous insulin infusion (CSII)), use of rapid- and long acting insulin analogues, NPH insulin, and frequency of self-monitoring of blood glucose (SMBG)/day. Models were adjusted for sex, diabetes duration, and migration background. P-value for trend was given.FindingsThe number of subjects with <3 injection time points/day decreased from 1995 to 2014 to <5% in all age-groups (p<0.0001). Proportion of patients with ≥4 injections/day increased until the early 2000s, and then declined until 2014. This trend was not found in 6-<12yr olds (p = 0.3403). CSII increased in all age-groups (p<0.0001) with the highest increase in children <6 years (from 0.4% to 79.2%), and the lowest increase in 12-<18 year olds (from 1.0% to 38.9%). NPH insulin decreased in all age-groups (p<0.0001). Insulin analogues, especially rapid-acting, became more frequent in all age-groups (p<0.0001), accounting for 78.4% in 2014 for all subjects. The highest use was found in the youngest children (in 2014: 85.6%), the lowest use in 6-<12 year olds (in 2014: 72.9%). The number of SMBG/day increased from 2.2 to 6.4 with a similar rise in all age-groups (p<0.0001). Frequency was highest in subjects <6yr.ConclusionsIn all age-groups, T1D treatment was intensified over the last 20 years. Age-specific differences in trends were particularly observed in the number of patients on CSII, in the number of patients with 4 or more injections/day, and in the frequency of SMBG/day.
Highlights
The German/Austrian Diabetes-Patienten-Verlaufsdokumentation (DPV) initiative was the first nationwide benchmarking launched in Germany in the year 1995
Age-specific differences in trends were observed in the number of patients on CSII, in the number of patients with 4 or more injections/day, and in the frequency of self-monitoring of blood glucose (SMBG)/day
The DPV initiative is based on three modules for diabetes documentation and quality management: 1. the DPV software which is used for continuous, longitudinal, prospective documentation of diabetes-related parameters, 2. external benchmarking for participating centres, and 3. a database for epidemiologic and medical research on diabetes
Summary
The German/Austrian Diabetes-Patienten-Verlaufsdokumentation (DPV) initiative was the first nationwide benchmarking launched in Germany in the year 1995. DPV focused initially on children and adolescents with diabetes and was extended to adult patients in 1997 [1]. An increase in intensified insulin therapy is reported in children and adolescents with type 1 diabetes [6,7,8]. Time trends in diabetes therapy might differ between age-groups due to different needs and preferences. Medical conditions such as a high risk of hypoglycemia in very young children [9], worse metabolic control or a higher frequency of mental disorders in adolescents [10,11,12] may lead to different treatment regimens. To investigate changes in diabetes treatment over the last two decades in three age-groups of children and adolescents with type 1 diabetes (T1D) from Germany and Austria
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