Patient and disease characteristics of adult patients with type 1 diabetes in Germany: an analysis of the DPV and DIVE databases

Abstract

Background: An understanding of the current status of patients with type 1 diabetes mellitus (T1DM) can help to provide appropriate treatment.

Methods: This was a retrospective analysis of the DIabetes Versorgungs-Evaluation (DIVE) and the Diabetes-Patienten-Verlaufsdokumentation (DPV) databases for Germany.

Results: The analysis included 56,250 people with T1DM (54.2% male), a median age of 36.8 years, and a median diabetes duration of 12.4 years. 15.3% were obese (body mass index ≥ 30kg/m²). Long-acting insulin analogs were used by 53.3%, short-acting analogs by 72.1%, and oral antidiabetic drugs by 4.7%. Patients had a median glycosylated hemoglobin (HbA1c) of 7.8%. There was a drop in HbA1c and an increase in the rate of hypertension, oral antidiabetic drug use, and in the rate of severe hypoglycemia (all p < 0.01) with age. Flash glucose monitoring (FGM) showed the best glucose values with fewer complications compared to other monitoring systems. HbA1c and FBG were lower in patients using a pump versus multiple daily injections (MDIs; 7.7 versus 7.9% and 7.8 versus 8.7 mmol/l; all adjusted p < 0.01). Patients had a lower risk of at least one severe hypoglycemic or DKA episode during the most recent treatment year with pump treatment compared to MDI (9.4% versus 10.5% and 4.7% versus 6.1%, both adjusted p < 0.01).

Conclusion: The data demonstrated less-than-optimal glycemic control in the young, an increasing metabolic pattern in T1DM with increasing age, a benefit of FGM to improve HbA1c control and adverse effects, as well as benefits of pump treatment over MDIs.

Keywords: age; epidemiology; glucose monitoring; type 1 diabetes.

Figure 1.

Data included in the present analysis. DIVE, DIabetes Versorgungs-Evaluation registry; DPV, Diabetes-Patienten-Verlaufsdokumentation database; T1DM, type 1 diabetes mellitus.

Figure 2.

Comorbidity and concomitant drug treatment. ^*Adjusted for age, sex and diabetes duration, calculated by logistic regression. Adj., adjusted; GLP, glucagon-like peptide; OAD, oral antidiabetic; LDL-C, low-density lipoprotein cholesterol; OAD, oral antidiabetic.

Figure 3.

Glucose control and safety overall and by age group. Median (and first and third quartiles). ^*Adjusted for age, sex and diabetes duration, calculated by logistic regression. Standardized international units for HbA1c: total 62 (52–76) mmol/mol; 18–25 years, 65 (54–79) mmol/mol; 26–49 years, 63 (52–79) mmol/mol; >49 years, 58 (51–69) mmol/mol. Adj., adjusted; FBG, fasting blood glucose; HbA1c, glycosylated hemoglobin; IQR, interquartile range.

Figure 4.

Glucose control and safety by monitoring method. Median (and first and third quartiles). ^*Adjusted for age, sex and diabetes duration, calculated by logistic regression. Standardized international units for HbA1c: SMBG 62 (52–75) mmol/mol, CGM 58 (43–86) mmol/mol, FGM 58 (52–68) mmol/mol. Adj., adjusted; CGM, continuous glucose monitoring; FBG, fasting blood glucose; FGM, flash glucose monitoring; HbA1c, glycosylated hemoglobin; IQR, interquartile range; SMBG, self-monitoring of blood glucose.

Figure 5.

Glycemic control and patients with at least one severe hypoglycemia and at least one diabetic ketoacidosis episode by insulin therapy. Median (and first and third quartiles). ^*Adjusted for age, sex and diabetes duration, calculated by logistic regression. Standardized international units for HbA1c: SMBG 61 (52–70) mmol/mol, CGM 63 (53–77) mmol/mol. Adj., adjusted; CGM, continuous glucose monitoring; FBG, fasting blood glucose; HbA1c, glycosylated hemoglobin; IQR, interquartile range; MDI, multiple daily injection; SMBG, self-monitoring of blood glucose.