Incidence, prevalence and care of type 1 diabetes in children and adolescents in Germany: Time trends and regional socioeconomic situation

Background: Trends over time and possible socio-spatial inequalities in the incidence and care of type 1 diabetes mellitus (T1D) in children and adolescents are important parameters for the planning of target-specific treatment structures. Methodology: The incidence and prevalence of type 1 diabetes, diabetic ketoacidosis and severe hypoglycaemia as well as the HbA1c value are presented for under 18-year-olds based on data from the nationwide Diabetes Prospective Follow-up Registry (DPV) and the diabetes registry of North Rhine-Westphalia. Indicators were mapped by sex over time between 2014 and 2020, and stratified by sex, age and regional socioeconomic deprivation for 2020. Results: In 2020, the incidence was 29.2 per 100,000 person-years and the prevalence was 235.5 per 100,000 persons, with the figures being higher in boys than in girls in either case. The median HbA1c value was 7.5%. Ketoacidosis manifested in 3.4% of treated children and adolescents, significantly more often in regions with very high (4.5%) deprivation than in regions with very low deprivation (2.4%). The proportion of severe hypoglycaemia cases was 3.0%. Between 2014 and 2020, the incidence, prevalence and HbA1c levels changed little, while the proportions of ketoacidosis and severe hypoglycaemia decreased. Conclusions: The decrease in acute complications indicates that type 1 diabetes care has improved. Similar to previous studies, the results suggest an inequality in care by regional socioeconomic situation

Incidence, prevalence and care of type 1 diabetes in children and adolescents in Germany: Time trends and regional socioeconomic situation

Background: Trends over time and possible socio-spatial inequalities in the incidence and care of type 1 diabetes mellitus (T1D) in children and adolescents are important parameters for the planning of target-specific treatment structures. Methodology: The incidence and prevalence of type 1 diabetes, diabetic ketoacidosis and severe hypoglycaemia as well as the HbA1c value are presented for under 18-year-olds based on data from the nationwide Diabetes Prospective Follow-up Registry (DPV) and the diabetes registry of North Rhine-Westphalia. Indicators were mapped by sex over time between 2014 and 2020, and stratified by sex, age and regional socioeconomic deprivation for 2020. Results: In 2020, the incidence was 29.2 per 100,000 person-years and the prevalence was 235.5 per 100,000 persons, with the figures being higher in boys than in girls in either case. The median HbA1c value was 7.5%. Ketoacidosis manifested in 3.4% of treated children and adolescents, significantly more often in regions with very high (4.5%) deprivation than in regions with very low deprivation (2.4%). The proportion of severe hypoglycaemia cases was 3.0%. Between 2014 and 2020, the incidence, prevalence and HbA1c levels changed little, while the proportions of ketoacidosis and severe hypoglycaemia decreased. Conclusions: The decrease in acute complications indicates that type 1 diabetes care has improved. Similar to previous studies, the results suggest an inequality in care by regional socioeconomic situation

Area deprivation and demographic factors associated with diabetes technology use in adults with type 1 diabetes in Germany

IntroductionDiabetes technology improves glycemic control and quality of life for many people with type 1 diabetes (T1D). However, inequalities in access to diabetes technology exist in many countries. In Germany, disparities in technology use have been described in pediatric T1D, but no data for adults are available so far. We therefore aimed to analyze whether demographic factors and area deprivation are associated with technology use in a representative population of adults with T1D.Materials and methodsIn adults with T1D from the German prospective diabetes follow-up registry (DPV), we analyzed the use of continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), and sensor augmented pump therapy (SAP, with and without automated insulin delivery) in 2019-2021 by age group, gender, migration background, and area deprivation using multiple adjusted regression models. Area deprivation, defined as a relative lack of area-based resources, was measured by quintiles of the German index of Multiple Deprivation (GIMD 2015, from Q1, least deprived, to Q5, most deprived districts).ResultsAmong 13,351 adults with T1D, the use of technology decreased significantly with older age: CSII use fell from 56.1% in the 18−<25-year age group to 3.1% in the ≥80-year age group, CGM use from 75.3% to 28.2%, and SAP use from 45.1% to 1.5% (all p for trend <0.001). The use of technology was also significantly higher in women than in men (CSII: 39.2% vs. 27.6%; CGM: 61.9% vs. 58.0%; SAP: 28.7% vs. 19.6%, all p <0.001), and in individuals without migration background than in those with migration background (CSII: 38.8% vs. 27.6%; CGM: 71.1% vs. 61.4%; SAP: 30.5% vs. 21.3%, all p <0.001). Associations with area deprivation were not linear: the use of each technology decreased only from Q2 to Q4.DiscussionOur real-world data provide evidence that higher age, male gender, and migration background are currently associated with lower use of diabetes technology in adults with T1D in Germany. Associations with area deprivation are more complex, probably due to correlations with other factors, like the higher proportion of migrants in less deprived areas or the federal structure of the German health care system

Inzidenz, Prävalenz und Versorgung von Typ-1-Diabetes bei Kindern und Jugendlichen in Deutschland: Zeittrends und sozialräumliche Lage

Hintergrund: Zeitliche Trends und mögliche sozialräumliche Ungleichheiten hinsichtlich der Häufigkeit und Versorgung von Typ-1-Diabetes mellitus (T1D) bei Kindern und Jugendlichen sind für die Planung von zielgerechten Behandlungsstrukturen von Bedeutung. Methode: Mit Daten der bundesweiten Diabetes-Patienten-Verlaufsdokumentation (DPV) und des Diabetesregisters in Nordrhein-Westfalen wurden für unter 18-Jährige Inzidenz und Prävalenz des Typ-1-Diabetes sowie HbA1c-Wert, diabetische Ketoazidosen und schwere Hypoglykämien dargestellt. Die Indikatoren wurden im Verlauf zwischen 2014 und 2020 nach Geschlecht und für 2020 stratifiziert nach Geschlecht, Alter und regionaler sozioökonomischer Deprivation abgebildet. Ergebnisse: 2020 betrug die Inzidenz 29,2 pro 100.000 Personenjahre und die Prävalenz 235,5 pro 100.000 Personen, mit jeweils höheren Werten bei Jungen als bei Mädchen. Der HbA1c-Wert betrug im Median 7,5 %. Bei 3,4 % der Behandelten trat eine Ketoazidose auf, signifikant häufiger in Regionen mit sehr hoher (4,5 %) als in Regionen mit sehr niedriger Deprivation (2,4 %). Der Anteil schwerer Hypoglykämien lag bei 3,0 %. Zwischen 2014 und 2020 änderten sich Inzidenz, Prävalenz und HbA1c-Wert kaum, während die Anteile von Ketoazidosen und schweren Hypoglykämien abnahmen. Schlussfolgerungen: Die Abnahme von Akutkomplikationen weist auf eine verbesserte Versorgung des Typ-1-Diabetes hin. Ähnlich wie in früheren Studien deuten die Ergebnisse eine Ungleichheit in der Versorgung nach sozialräumlicher Lage an

Inzidenz, Prävalenz und Versorgung von Typ-1-Diabetes bei Kindern und Jugendlichen in Deutschland: Zeittrends und sozialräumliche Lage

Hintergrund: Zeitliche Trends und mögliche sozialräumliche Ungleichheiten hinsichtlich der Häufigkeit und Versorgung von Typ-1-Diabetes mellitus (T1D) bei Kindern und Jugendlichen sind für die Planung von zielgerechten Behandlungsstrukturen von Bedeutung. Methode: Mit Daten der bundesweiten Diabetes-Patienten-Verlaufsdokumentation (DPV) und des Diabetesregisters in Nordrhein-Westfalen wurden für unter 18-Jährige Inzidenz und Prävalenz des Typ-1-Diabetes sowie HbA1c-Wert, diabetische Ketoazidosen und schwere Hypoglykämien dargestellt. Die Indikatoren wurden im Verlauf zwischen 2014 und 2020 nach Geschlecht und für 2020 stratifiziert nach Geschlecht, Alter und regionaler sozioökonomischer Deprivation abgebildet. Ergebnisse: 2020 betrug die Inzidenz 29,2 pro 100.000 Personenjahre und die Prävalenz 235,5 pro 100.000 Personen, mit jeweils höheren Werten bei Jungen als bei Mädchen. Der HbA1c-Wert betrug im Median 7,5 %. Bei 3,4 % der Behandelten trat eine Ketoazidose auf, signifikant häufiger in Regionen mit sehr hoher (4,5 %) als in Regionen mit sehr niedriger Deprivation (2,4 %). Der Anteil schwerer Hypoglykämien lag bei 3,0 %. Zwischen 2014 und 2020 änderten sich Inzidenz, Prävalenz und HbA1c-Wert kaum, während die Anteile von Ketoazidosen und schweren Hypoglykämien abnahmen. Schlussfolgerungen: Die Abnahme von Akutkomplikationen weist auf eine verbesserte Versorgung des Typ-1-Diabetes hin. Ähnlich wie in früheren Studien deuten die Ergebnisse eine Ungleichheit in der Versorgung nach sozialräumlicher Lage an

Etat des lieux des pratiques de gestion de la maladie de Mortellaro par les éleveurs de bovins

Le but de cette thèse est de connaître les pratiques de gestion réalisées par les éleveurs pour lutter contre la maladie de Mortellaro et la satisfaction des éleveurs par rapport à leur pratique. Pour cela, l auteur a réalisé une enquête dans 65 élevages de différentes régions de France. Une multitude de traitements a été répertoriée : 9 procédés différents de traitement associés à 57 produits différents ont mené à un total de 95 traitements réalisés par les 65 éleveurs. Le traitement jugé le plus satisfaisant est le traitement individuel par application locale d oxytétracycline. Par ailleurs, l efficacité des traitements collectifs est difficilement perçue par les éleveurs. Cependant, ils pensent que ces traitements peuvent être une aide pour gérer la maladie de Mortellaro. En effet les éleveurs qui rapportent une prévalence élevée de la maladie dans leur troupeau sont ceux qui réalisent des traitements collectifs en plus des traitements individuels.TOULOUSE-EN Vétérinaire (315552301) / SudocNANTES-Ecole Nat.Vétérinaire (441092302) / SudocSudocFranceF

An integrated wheat breeding programme for sustainable agriculture in France

International audienc

Heterogeneity of Access to Diabetes Technology Depending on Area Deprivation and Demographics Between 2016 and 2019 in Germany

Background: Despite increasing use of technology in type 1 diabetes, persistent ethnic and socio-economic disparities have been reported. We analyzed how the use of insulin pump therapy and continuous glucose monitoring (CGM) evolved over the years in Germany depending on demographics and area deprivation. Method: We investigated the use of insulin pump and CGM between 2016 and 2019 in 37,798 patients with type 1 diabetes aged<26years from the German Prospective Follow-up Registry (DPV). Associations with federal state, area-deprivation quintile (German Index of Multiple Deprivation 2010 on district level), gender, and migration background were investigated over time using multiple logistic regression. Results: Between 2016 and 2019, the regional distribution of insulin pump use did not change substantially and the association with area deprivation remained non-linear and statistically non-significant. The effect of area deprivation on CGM use decreased continuously and disappeared in 2019 (OR [95%-CI] Q1 vs Q5: 1.85 [1.63-2.10] in 2016; 0.97 [0.88-1.08] in 2019). The effect of migration background on the use of either technology decreased over the years but remained significant in 2019. Girls had constantly higher odds of using an insulin pump than boys (OR: 1.25 [1.18-1.31] in 2019), whereas no gender difference was identified for CGM use. Conclusions: Although disparities decreased in Germany, access to diabetes technology still depends on migration background in 2019, and gender differences in pump use persist. As technological advances are made, further research is needed to understand the reasons for these persistent disparitie

Hospitalization in pediatric diabetes : a nationwide analysis of all admission causes for Germany in 2015

Introduction Regarding pediatric diabetes, hospital admission for acute complications of type 1 diabetes (T1D) has often been investigated, but little is known about other causes of hospitalization. This study aimed to explore the total burden of hospitalization in individuals with diabetes <20 years of age in Germany. Methods Using the German Diagnosis-Related Groups data for 2015, we examined the frequencies of hospitalization with diabetes (20,251 inpatient cases), stratified by diabetes type [T1D, type 2 diabetes (T2D), other specified diabetes types (T3D), and unclear diabetes], and without diabetes (1,269,631 inpatient cases). Using estimates of the population at risk with T1D, T2D, and without diabetes, we evaluated hospitalization rates (per patient-year) by Poisson regression. For T1D, T2D, and T3D, we investigated the most frequent diagnoses and the median length of stay. Most analyses were stratified by sex, age-group and east/west residence. Results Children and adolescents with diabetes had a 6 to 9 times higher hospitalization risk than peers without diabetes (hospitalization rate 0.09). The hospitalization rate was higher for T2D compared with T1D (0.84 vs. 0.53, P<0.001). In T2D, two-third of inpatient cases were not directly related to diabetes, and stay was shorter compared with T1D and T3D (3 vs. 4 and 5 days, respectively). In T1D, hospitalization was more frequent among girls than boys (0.58 vs. 0.49, P<0.001), and mostly due to “diabetes without complications” (65.7%). Hospitalization tended to be more frequent and longer in the youngest patients, and in those with east residence. Conclusion Hospitalization rate in pediatric diabetes in Germany remained high, especially for T2D patients, girls with T1D, and young children

Use of insulin pump therapy is associated with reduced hospital-days in the long-term: a real-world study of 48,756 pediatric patients with type 1 diabetes

In pediatric diabetes, insulin pump therapy is associated with less acute complications but inpatient pump education may lead to more hospital days. We investigated the number of hospital days associated with pump vs. injection therapy between 2009 and 2018 in 48,756 patients with type 1 diabetes &amp;lt; 20 years of age from the German Diabetes Prospective Follow-up Registry (DPV). Analyses were performed separately for hospitalizations at diagnosis (hierarchical linear models adjusted for sex, age, and migration), and for hospitalizations in the subsequent course of the disease (hierarchical Poisson models stratified by sex, age, migration, and therapy switch). At diagnosis, the length of hospital stay was longer with pump therapy than with injection therapy (mean estimate with 95% CI: 13.6 [13.3-13.9] days vs. 12.8 [12.5-13.1] days, P &amp;lt; 0.0001), whereas during the whole follow-up beyond diagnosis, the number of hospital days per person-year (/PY) was higher with injection therapy than with pump therapy (4.4 [4.1-4.8] vs. 3.9 [3.6-4.2] days/PY), especially for children under 5 years of age (4.9 [4.4-5.6] vs. 3.5 [3.1-3.9] days/PY).Conclusions: Even in countries with hospitalizations at diabetes diagnosis of longer duration, the use of pump therapy is associated with a reduced number of hospital days in the long-term. What is known: • In pediatric diabetes, insulin pump therapy is associated with better glycemic control and less acute complications compared with injection therapy. • However, pump therapy implies more costs and resources for education and management. What is new: • Even in countries where pump education is predominantly given in an inpatient setting, the use of pump therapy is associated with a reduced number of hospital days in the long-term. • Lower rates of hospitalization due to acute complications during the course of the disease counterbalance longer hospitalizations due to initial pump education