Mobile Diabetes Education and Care: Intervention for Children and Youth with Type 1 Diabetes in Rural Areas of Northern Germany

OBJECTIVE Intervention to improve quality of care of children with type 1 diabetes and limited access to speciality diabetes care in rural areas by a mobile diabetes education and care team, which is affiliated with a pediatric diabetes center of a university hospital. RESEARCH DESIGN AND METHODS A cohort study with 107 participating children and their families from eight rural hospitals was carried out between July 2000 and July 2002. Parameters on quality of metabolic control (HbA1c, hospitalisation rate and number of severe hypoglycemia), diabetes knowledge and quality of life at baseline (t0), six weeks (t1) and six months (t2) after the interventions were investigated

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