Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Aug 17;11(8):e0160971.
doi: 10.1371/journal.pone.0160971. eCollection 2016.

20 Years of Pediatric Benchmarking in Germany and Austria: Age-Dependent Analysis of Longitudinal Follow-Up in 63,967 Children and Adolescents with Type 1 Diabetes

Barbara Bohn  1   2 , Beate Karges  3   4   5 , Christian Vogel  6 , Klaus-Peter Otto  7 , Wolfgang Marg  8 , Sabine E Hofer  9 , Elke Fröhlich-Reiterer  10 , Martin Holder  11 , Michaela Plamper  12 , Martin Wabitsch  13 , Wolfgang Kerner  14 , Reinhard W Holl  1   2 ; DPV Initiative
Affiliations

20 Years of Pediatric Benchmarking in Germany and Austria: Age-Dependent Analysis of Longitudinal Follow-Up in 63,967 Children and Adolescents with Type 1 Diabetes

Barbara Bohn et al. PLoS One. .

Abstract

Background: 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.

Methods: 63,967 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.

Findings: The 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.

Conclusions: In 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.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Selection of study population.
Fig 2
Fig 2
Frequency of a) 1–2 injections per day, b) 3 injections per day, c) 4 or more injections per day, and d) use of insulin pumps in pediatric patients with type 1 diabetes, stratified by calendar year and age-groups. Data adjusted for sex, diabetes duration, and migratory background.
Fig 3
Fig 3
Use of a) NPH insulin, b) long-acting insulin analogues, c) rapid-acting insulin analogues, and d) SMBG per day in pediatric patients with type 1 diabetes, stratified by calendar year and age-groups. Data adjusted for sex, diabetes duration, and migratory background.
Fig 4
Fig 4
Frequency of SMBG per day in a) subjects with ICT, and b) subjects with insulin pumps, stratified by calendar year and age-groups. Data adjusted for sex, diabetes duration, and migratory background (data for small number of cases <20 are not shown).
See this image and copyright information in PMC

References

    1. Grabert M, Schweiggert F, Holl RW. A framework for diabetes documentation and quality management in Germany: 10 years of experience with DPV. Comput Methods Programs Biomed. 2002;69: 115–121. - PubMed
    1. Icks A, Strassburger K, Baechle C, Rosenbauer J, Giani G, Beyer P, et al. Frequency and cost of diabetic ketoacidosis in Germany–study in 12 001 paediatric patients. Exp Clin Endocrinol Diabetes. 2013;121: 58–59. 10.1055/s-0032-1312639 - DOI - PubMed
    1. Karges B, Rosenbauer J, Kapellen T, Wagner VM, Schober E, Karges W, et al. Hemoglobin A1c levels and risk of severe hypoglycemia in children and young adults with type 1 diabetes from Germany and Austria: a trend analysis in a cohort of 37,539 patients between 1995 and 2012. PLoS Med. 2014;11: e1001742 10.1371/journal.pmed.1001742 - DOI - PMC - PubMed
    1. Rohrer TR, Wolf J, Liptay S, Zimmer KP, Fröhlich-Reiterer E, Scheuing N, et al. Microvascular complications in childhood-onset type 1 diabetes and celiac disease: A multicenter longitudinal analysis of 56,514 patients from the German-Austrian DPV database. Diabetes Care. 2015;38: 801–807. 10.2337/dc14-0683 - DOI - PubMed
    1. Danne T, Lange K, Kordonouri O. New developments in the treatment of type 1 diabetes in children. Arch Dis Child 2007;92: 1015–1019. - PMC - PubMed

MeSH terms