The association between socio-economic status and diabetes care and outcome in children with diabetes type 1 in Germany: The DIAS study (diabetes and social disparities).

OBJECTIVE: To evaluate the association between socioeconomic status (SES) and diabetes outcomes in German children and adolescents. METHODS: A total of 1829 subjects <18 years old with type 1 diabetes mellitus from 13 German diabetes centers were included from June 2013 until June 2014. Data were collected within the multicenter DPV (Diabetes Prospective Follow-up) registry. SES was measured with a composite index. Multivariable regression models were applied to analyze the association of SES and outcomes adjusted for age, sex, diabetes duration, and migration status. RESULTS: Low SES was significantly associated with worse diabetes outcomes: higher hemoglobin A1C (HbA1c) (64.3 mmol/mol), lower proportion of insulin pump therapy (43.6%), fewer daily self-monitored blood glucose (SMBG) measurements (5.7), more inpatient days per patient-year (5.8) compared to patients with medium/high SES (HbA1c: 61.3 mmol/mol, P < 0.001/59.8 mmol/mol, P < 0.0001; proportion of pump therapy: 54.5%, P < 0.01/ 54.9%, P < 0.01; SMBG: 6.0, P < 0.01/ 6.1, P < 0.01; inpatient days: 4.5, P < 0.0001/3.4, P < 0.0001). The inclusion of migration status in the models resulted in only minor changes in the outcomes. CONCLUSION: Despite free health care, low SES is associated with unfavorable diabetes outcomes in Germany. The poorer diabetes outcomes of children with diabetes have been attributed to their migration status and may be partly explained by low SES. Both factors must become part of targeted diabetes care in children and adolescents with type 1 diabetes.

Hemoglobin A1c is a reliable criterion for diagnosing type 1 diabetes in childhood and adolescence.

BACKGROUND: Little is known about the use of the hemoglobin A1C (HbA1c) test for the diagnosis of diabetes in childhood and adolescence. The aim is to investigate sensitivity and specificity of HbA1c at onset of childhood type 1 diabetes. METHODS: A total of 184 children and adolescents with blood glucose levels above 200 mg/dL (11.1 mmol/L) were included: 84.8% (n = 156, mean age 9.0 yr) with new onset of type 1 diabetes, 15.2% (n = 28, mean age 6.1 yr) with transient hyperglycemia. HbA1c was measured using the Bayer(®) DCA2000 analyzer. RESULTS: Patients with new onset of type 1 diabetes (n = 156) had HbA1c values between 6.6% and > 14% (mean (SD) 11.4 (2.0)%; IQR, interquartile range 9.8-13.3%). All patients suffered from typical symptoms of hyperglycemia, i.e., polyuria and polydipsia. In the patient group with transient hyperglycemia (n = 28), HbA1c values were between 4.5 and 6.1% (mean (SD) 5.3 (0.4)%; IQR 5.0-5.6%). None of these patients reported typical symptoms of diabetes. All patients with HbA1c values greater than 6.35% had new onset of type 1 diabetes. Sensitivity of HbA1c at the onset of childhood type 1 diabetes was calculated to be 100%. In patients with HbA1c values less than 6.35%, the diagnosis of type 1 diabetes could be excluded. Thus, specificity of HbA1c as diagnostic criterion was 100%. CONCLUSIONS: Childhood type 1 diabetes can be diagnosed and excluded with high reliability by means of HbA1c testing.

Type 2 diabetes mellitus in children and adolescents is still a rare disease in Germany: a population-based assessment of the prevalence of type 2 diabetes and MODY in patients aged 0-20 years.

OBJECTIVE: To assess the prevalence of type 2 diabetes mellitus (T2DM) and maturity onset diabetes of the young (MODY) in children and adolescents aged 0-20 yr in Baden-Württemberg (BW), Germany, and to compare our results with those from other European countries. METHODS: Our study involved every children's hospital (n = 31), each diabetologist in private practice (n = 122), and every internal medicine unit (n = 164) in BW. A written questionnaire and a telephone survey were used to identify children with T2DM and MODY who had been examined at any of these institutions between 2004 and 2005. Population data were drawn from the national census of 1987 and the subsequent annual updates. RESULTS: The prevalence of T2DM for the age range from 0 to 20 yr is 2.30/100 000, whereas the prevalence of MODY in the same age range is 2.39/100 000. The median age of patients with T2DM was 15.8 yr, and 13.9 yr for MODY patients. The majority of patients with either T2DM or MODY were treated in children's hospitals and by consultant diabetologists. A molecular genetic analysis was done to substantiate the clinical diagnosis in less than half of the recruits (14.3% of T2DM and 44.8% of MODY patients). CONCLUSIONS: The prevalence of T2DM and MODY is considerably lower than the prevalence of type 1 diabetes. Type 2 diabetes thus continues to be a rare disease in children and adolescents in Germany, as is also the case in other European countries.