Expected Basal Insulin Requirement during CSII therapy by Age Group, Sex and BMI, based on 25,718 Young People with Type 1 Diabetes in the DPV Registry.

Background Since the introduction of insulin pumps into the therapy of paediatric subjects, different approaches have been taken to find optimal basal rates. Previously, the DPV registry provided circadian basal rate patterns for different age groups. As the number of pump users has increased recently and short-acting insulin analogues are now predominant, we performed a new analysis with a larger data pool. Methods We included all recent basal profiles from T1D patients between 1 and 25 years from the DPV 2021 data pool. We excluded night-time-only pump users, human regular insulin users, and daily basal rates 1.0 U/kgBW/d. Results In the analysis of profiles from 25,718 young persons with T1D, differences in the daily pattern of basal rates were found between age groups. In addition, we saw significant (p<0.001) differences in total daily basal dose between genders in all age groups except adults. In addition, the shape of the expected basal-rate pattern differed by BMI, HbA1c and use of continuous glucose monitoring. Discussion This analysis demonstrates multiple factors influencing basal patterns and insulin requirement, including age group, gender, overweight, HbA1c, bolus frequency and sensor use. As circadian basal rates are still mandatory for initiating insulin pump therapy with or without automation, a multimodal approach is necessary to estimate optimal basal rates

Estimated Glomerular Filtration Rates Calculated by New and Old Equations in Children and Adolescents With Type 1 Diabetes-What to Do With the Results?

Background: To apply and evaluate various equations for estimated glomerular filtration rates (eGFR) in a large paediatric type 1 diabetes population and compare the eGFR values with urinary creatinine clearances (UCC) in a subset of patients. Methods: Six eGFR formulae applicable for children and adolescents were used for calculation of eGFR values in 36,782 children/adolescents with type 1 diabetes. Via regression models, factors influencing eGFR values were identified. eGFR values were compared with measured UCC in 549 patients. Spearman correlation coefficients were given to assess the relation of eGFR and UCC values. Bland-Altman-Plots with corresponding linear regression were drawn to evaluate the agreement between eGFR and UCC. Results: eGFR values differed widely depending on the formula used, resulting in a percentage of pathological values <60 mL/min/1.73 m2 up to 8%. Regression models showed age, sex, and duration of diabetes as influencing factors. Microalbuminuria was associated with significantly higher eGFR values for all formulae. In comparison of eGFR with UCC, the highest correlation coefficient was 0.33, the lowest 0.01. Bland-Altman-Plots demonstrated graphically a poor agreement between eGFR and UCC, regardless of the formula used. Conclusions: The broad range of eGFR values indicate that an ideal eGFR formula for children and adolescence with T1D is yet missing. The minimal agreement between measured UCC and eGFR values urges us to be careful in application and interpretation of eGFR values regardless of the formula used

Health-related quality of life among adolescents with type 1 diabetes since the second wave of the COVID-19 pandemic in Germany

Objective The COVID-19 pandemic had an impact on everyday life and in general, reduced the health-related quality of life (HRQoL) of adolescents. In this study, we assess the HRQoL of adolescents with type 1 diabetes (T1D) in Germany since the second wave of the COVID-19 pandemic by using self-report and parent-proxy reports, to identify risk factors, to compare to peers and to examine the agreement of HRQoL between parents and their children.Methods A total of 445 adolescents (12–18 years) and 413 parents participated in an anonymous cross-sectional survey conducted at three German diabetes centres from January 2021 to June 2022. Inclusion criteria were diabetes duration ≥1 year and German-speaking. Teen HRQoL was assessed by using self-report and parent-proxy report versions of the KIDSCREEN-10 index.Results The majority of adolescents reported average (75.5%) HRQoL. Approximately 11.3% of teens reported high and 13.2% low HRQoL. Teen’s female gender, older age, higher diabetes burden and parental depression symptoms contributed to lower self-reported HRQoL among teens. For parent-proxy reports, increasing diabetes burdens, parental depression symptoms, non-migrant status, high education and ketoacidosis contributed to lower scores on teen HRQoL. The mean scores of the KIDSCREEN-10 index for adolescents did not differ from the German norm. In comparison to healthy peers during the first wave of the pandemic, adolescents in the current study reported higher HRQoL. The overall teen-parent agreement was fair although parents reported significantly lower teen HRQoL than adolescents did.Conclusions HRQoL of most adolescents with T1D during the COVID-19 pandemic was average with parents reporting significantly lower scores. Self-reported and parent-proxy-reported HRQoL and the level of agreement due to different perspectives can provide important information for clinical care and intervention planning

Lower Frequency of Insulin Pump Treatment in Children and Adolescents of Turkish Background with Type 1 Diabetes: Analysis of 21,497 Patients in Germany

Icks A, Razum O, Rosenbauer J, et al. Lower Frequency of Insulin Pump Treatment in Children and Adolescents of Turkish Background with Type 1 Diabetes: Analysis of 21,497 Patients in Germany. Diabetes Technology &amp; Therapeutics. 2012;14(12):1105-1109.Aim: This study investigated insulin pump therapy in pediatric patients with type 1 diabetes and Turkish origin compared with those without migration background in Germany. Subjects and Methods: Using a nationwide documentation program, we estimated the prevalence of insulin pump therapy in patients <20 years of age with Turkish origin and those without migration background. Logistic regression was used to adjust for age, sex, diabetes duration, body mass index SD score (BMI-SDS), glycated hemoglobin, number of outpatient visits, number of daily blood glucose self-measurements, and area-based socioeconomic conditions. Results: In 1,695 pediatric type 1 diabetes patients with Turkish background and 19,802 patients without migration background (respectively: 51.2% and 53.0% boys; mean age, 12.4 +/- 4.1 and 12.6 +/- 4.2 years; mean diabetes duration, 4.7 +/- 3.9 and 5.3 +/- 4.0 years), fully adjusted prevalences of insulin pump therapy were 18.5% and 30.9%, respectively (odds ratio 0.51, 95% confidence interval 0.43-0.60, P < 0.001). Age, sex, BMI-SDS, outpatient visits, and blood glucose self-control were significantly associated with the prevalence of insulin pump therapy but did not alter the difference substantially. Conclusions: The prevalence of insulin pump therapy is roughly half among pediatric diabetes patients with Turkish background compared with those without migration background. Several covariates could not explain this difference. Individual characteristics or access barriers within the healthcare system may play a role. Further research is needed

Understanding Daily, Emotional, and Physical Burdens and Needs of Parents Caring for Children with Type 1 Diabetes

Aims. To investigate (1) daily, emotional, and physical caregiving burdens in parents of children with type 1 diabetes, (2) the sociodemographic and clinical predictors of three burdens, and (3) support measures that parents wish to receive. Methods. The study was a multicenter cross-sectional survey conducted in nine German pediatric diabetes centers. A questionnaire assessing three types of burdens and wishes for support was distributed to parents with a child with type 1 diabetes visiting one of the pediatric centers for a routine check-up. Results. Data from 1,107 parents (83% mothers) were analyzed. Parents reported significantly higher emotional burdens compared to daily and physical burdens (p<0.0001). Mothers felt more burdened than fathers did. Parents of younger children reported higher daily and physical burdens compared to the parents of older children, and similarly, parents of technology users reported higher daily and physical burdens compared to the parents of nontechnology users. However, emotional burdens did not differ in both comparisons. Other demographic factors (i.e., parent’s age, migration status, and single-parent family status) predicted high levels of daily or physical burdens, but only HbA1c level and the parent’s gender (mother) predicted a high emotional burden. Independent of the level of burden, 78% of parents wanted additional diabetes training. Conclusion. Despite parents reporting high emotional burdens in connection with diabetes care, HbA1c and the gender of the reporting parent were the only risk factors. As the child gets older, parents’ daily and physical distress decrease but not the emotional burden. Diabetes training including regularly offered booster sessions as well as low-threshold interventions for mental health issues and practical self-care skills is recommended to provide continuous support for parents

Long-Term Occupational Consequences for Families of Children With Type 1 Diabetes: The Mothers Take the Burden

Dehn-Hindenberg A, Saßmann H, Berndt V, et al. Long-Term Occupational Consequences for Families of Children With Type 1 Diabetes: The Mothers Take the Burden. Diabetes Care. 2021: dc210740.OBJECTIVE: To investigate the occupational and financial consequences for parents following the onset of type 1 diabetes in their child.; RESEARCH DESIGN AND METHODS: A questionnaire assessing occupational and financial situations before and in the first year after the onset of diabetes was distributed to all families with a child ≤14 years of age at diagnosis with a diabetes duration of at least 12 months in nine German pediatric diabetes centers.; RESULTS: Data of 1,144 children (mean age at diagnosis 6.7 [3.6] years; 46.5% female) and their families were obtained. Mothers' occupational status reflected in paid working hours was significantly reduced in the first year after their child's diabetes diagnosis (P < 0.001). Overall, 15.1% of mothers stopped working, and 11.5% reduced working hours. Mothers of preschool children were particularly affected. Fathers' working status hardly changed (P = 0.75). Nearly half of the families (46.4%) reported moderate to severe financial losses. Compared with an earlier similar study in 2003, significant negative occupational consequences for mothers and financial burden on families remained unchanged in 2018 (P = 0.59 and 0.31, respectively).; CONCLUSIONS: Mothers of young children with newly diagnosed diabetes experienced negative consequences in their occupational situation. This inequality for mothers can have long-term negative consequences for their mental health and future economic situation. There is an urgent need for action to reduce the burden on families and to provide professional, social, and regulatory support, especially for mothers of young children with diabetes. © 2021 by the American Diabetes Association

The association between educational status and diabetes outcomes: results of the DIAS study in children with diabetes type 1 in Germany

Objective To evaluate the association between parents' educational status and diabetes outcomes in German children and adolescents and to compare educational status and individual socioeconomic status (SES). Methods The study included a total of 1781 patients < 18 years old with type 1 diabetes mellitus from 13 German diabetes centers. The analysis was based on data from the DIAS study collected from June 2013 until June 2014 in order to analyse the associations of SES and various diabetes outcomes. The DIAS study measured SES with a composite index based on parents' educational status, occupational status and household income and presented unfavourable outcomes for patients with a low SES. In a secondary analysis of the DIAS data, analyses have been run again with parents' educational status only in order to examine its applicability as a short indicator of SES. Data were collected within the multicenter DPV ( Diabetes Prospective Follow- up) registry. Multivariable regression models ( linear, logistic, negativ-binomial or Poisson- models depending on the distributional characteristics of the outcomes) were applied to analyze the associations of parents' educational status and diabetes outcomes, adjusted for age, sex, diabetes duration, and eventually migration background. Results Low educational status was significantly associated with higher hemoglobin A1C (HbA1c) compared to medium/high educational status (8,1 % compared to 7,8 %, p < 0,0001/ 7,6 %, p < 0,0001), and lower proportion of insulin pump therapy (42,7 % versus 56,3 %, p < 0,0001/52,5 %, p < 0,01). Patients with a background of low educational status also reported fewer daily self- monitored blood glucose (SMBG) measurements, higher Body-Mass-Index, and more inpatient days per year. Severe hypoglycemic events and ketoacidosis were not more frequent in patients with low educational status. The educational status measure was able to discriminate between the social groups as well as the complex SES measure. Conclusion Parents' low educational status is an important predictor for unfavorable outcomes in German children with type-1 diabetes. We should incorporate this aspect in targeted diabetes care and education. As a short and practicable indicator, parents' educational status can estimate the social status of the patients in routine collection of diabetes data

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