Hospitalization in Pediatric Diabetes: A Nationwide Analysis of all Admission Causes for Germany in 2015Funding This work was supported by the German Center for Diabetes Research (DZD), by the German Diabetes Association (DDG), by the Association of Diabetic Children and Adolescents (BdKJ), and by the Robert Koch Institute (RKI). The ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, receives funding from the Innovative Medicines Initiative 2 Joint Undertaking INNODIA under grant agreement 115797, supported by the European Commission’s Horizon 2020 research and innovation program and European Federation of Pharmaceutical Industries and Associations, JDRF, and The Leona M. and Harry B. Helmsley Charitable Trust.
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.
Key wordsType 1 diabetes - type 2 diabetes - pancreatic diabetes - comorbidities - secondary data analysis - German DRG.
Received: 14 May 2019
Received: 02 July 2019
Accepted: 09 July 2019
19 August 2019 (online)
© Georg Thieme Verlag KG
Stuttgart · New York
- 1 Bohn B, Schwandt A, Ihle P. et al. Hospital admission in children and adolescents with or without type 1 diabetes from Germany: An analysis of statutory health insurance data on 12 million subjects. Pediatr Diabetes 2018; 19: 721-726
- 2 Bachle CC, Holl RW, Strassburger K. et al. Costs of paediatric diabetes care in Germany: Current situation and comparison with the year 2000. Diabet Med 2012; 29: 1327-1334
- 3 Sayers A, Thayer D, Harvey JN et al. Evidence for a persistent, major excess in all cause admissions to hospital in children with type-1 diabetes: Results from a large Welsh national matched community cohort study. BMJ Open 2015; 5: e005644-2014-005644
- 4 Clapin H, Hop L, Ritchie E. et al. Home-based vs. inpatient education for children newly diagnosed with type 1 diabetes. Pediatr Diabetes 2017; 18: 579-587
- 5 Morgan-Trimmer S, Channon S, Gregory JW. et al. Family preferences for home or hospital care at diagnosis for children with diabetes in the DECIDE study. Diabet Med 2016; 33: 119-124
- 6 Karges B, Rosenbauer J, Holterhus PM. et al. Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31 330 young patients with type 1 diabetes. Eur J Endocrinol 2015; 173: 341-350
- 7 Icks A, Rosenbauer J, Holl RW. et al. Hospitalization among diabetic children and adolescents and the general population in Germany. German Working Group for Pediatric Diabetology. Diabetes Care 2001; 24: 435-440
- 8 Curtis JR, To T, Muirhead S. et al. Recent trends in hospitalization for diabetic ketoacidosis in ontario children. Diabetes Care 2002; 25: 1591-1596
- 9 Konrad K, Vogel C, Bollow E. et al. Current practice of diabetes education in children and adolescents with type 1 diabetes in Germany and Austria: Analysis based on the German/Austrian DPV database. Pediatr Diabetes 2016; 17: 483-491
- 10 Auzanneau M, Lanzinger S, Bohn B. et al. Area deprivation and regional disparities in treatment and outcome quality of 29 284 pediatric patients with type 1 Diabetes in Germany: A cross-sectional multicenter DPV analysis. Diabetes Care 2018; 41: 2517-2525
- 11 Woodward M. Epidemiology – Study Design and Data Analysis. London, New York: pp 223 Chapman & Hall/CRC; 1999
- 12 Patterson CC, Harjutsalo V, Rosenbauer J. et al. Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centres in the 25 year period 1989–2013: A multicentre prospective registration study. Diabetologia 2019; 62: 408-417
- 13 Goffrier B, Schulz M, Bätzing-Feigenbaum J. Administrative Prävalenzen und Inzidenzen des Diabetes mellitus von 2009 bis 2015 - Versorgungsatlas-Bericht Nr. 17/03. Berlin: 2017
- 14 German Federal Statistical Office (Destatis). Ergebnisse auf Grundlage des Zensus 2011. 31:December 2016; https://www-genesis.destatis.de/genesis/online Accessed 5 November 2018
- 15 Gesundheit . Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik). 2015. Fachserie 12 Reihe 6.4. ed Wiesbaden: Statistisches Bundesamt; 2016
- 16 Naughton MJ, Ruggiero AM, Lawrence JM. et al. Health-related quality of life of children and adolescents with type 1 or type 2 diabetes mellitus: SEARCH for Diabetes in Youth Study. Arch Pediatr Adolesc Med 2008; 162: 649-657
- 17 Pulgaron ER. Childhood obesity: A review of increased risk for physical and psychological comorbidities. Clin Ther 2013; 35: A18-A32
- 18 Pinhas-Hamiel O, Zeitler P. Acute and chronic complications of type 2 diabetes mellitus in children and adolescents. Lancet 2007; 369: 1823-1831
- 19 Estrada CL, Danielson KK, Drum ML. et al. Hospitalization subsequent to diagnosis in young patients with diabetes in Chicago, Illinois. Pediatrics 2009; 124: 926-934
- 20 Cohn BA, Cirillo PM, Wingard DL. et al. Gender differences in hospitalizations for IDDM among adolescents in California, 1991. Implications for prevention. Diabetes Care 1997; 20: 1677-1682
- 21 Lipton RB, Zierold KM, Drum ML. et al. Re-hospitalization after diagnosis of diabetes varies by gender and socioeconomic status in urban African-American and Latino young people. Pediatr Diabetes 2002; 3: 16-22
- 22 Samuelsson U, Anderzen J, Gudbjornsdottir S. et al. Teenage girls with type 1 diabetes have poorer metabolic control than boys and face more complications in early adulthood. J Diabetes Complications 2016; 30: 917-922
- 23 Frohlich-Reiterer EE, Rosenbauer J, Bechtold-Dalla Pozza S. et al. Predictors of increasing BMI during the course of diabetes in children and adolescents with type 1 diabetes: Data from the German/Austrian DPV multicentre survey. Arch Dis Child 2014; 99: 738-743
- 24 Hilgard D, Johannsen C, Herbst A. et al. Development in hospitalisation and average length of hospital stay in children and youth with diabetes mellitus type 1 in 1995–2005 [in German]. Diabetol Stoffwechs 2007; 2: 153-160
- 25 Bachle C, Haastert B, Holl RW. et al. Inpatient and outpatient health care utilization of children and adolescents with type 1 diabetes before and after introduction of DRGs. Exp Clin Endocrinol Diabetes 2010; 118: 644-648
- 26 Holl R, Prinz N. Medizinische Versorgung von Kindern und Jugendlichen mit Diabetes – Entwicklungen der letzten 21 Jahre. In: Deutsche Diabetes Gesellschaft (DDG) und diabetes DE ed Deutscher Gesundheitsbericht Diabetes; 2017: 132-143
- 27 Ziegler AG, Hoffmann GF, Hasford J. et al. Screening for asymptomatic beta-cell autoimmunity in young children. Lancet Child Adolesc Health 2019; 3: 288-290
- 28 Korbel L, Easterling RS, Punja N. et al. The burden of common infections in children and adolescents with diabetes mellitus: A Pediatric Health Information System study. Pediatr Diabetes 2018; 19: 512-519
- 29 Cameron FJ, Amin R, de Beaufort C. et al. ISPAD Clinical Practice Consensus Guidelines 2014. Diabetes in adolescence. Pediatr Diabetes 2014; 15 (Suppl. 20) 245-256
- 30 Albrech J, Fink P, Tiemann H. Unequal Germany: socio-economic disparity report 2015. [German]: www.fes-2017plus.de Friedrich-Ebert-Stiftung; 2016
- 31 Lampert T, Prütz F, Rommel A. et al. Social differences in the utilization of medical services by children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study. Journal of Health Monitoring 2018; 3: 35-51
- 32 Apperley LJ, Ng SM. Socioeconomic deprivation, household education, and employment are associated with increased hospital admissions and poor glycemic control in children with type 1 Diabetes mellitus. Rev Diabet Stud 2017; 14: 295-300
- 33 Lanzinger S, Welters A, Thon A et al. Comparing clinical characteristics of pediatric patients with pancreatic diabetes to patients with type 1 diabetes – a matched case-control study. Pediatr Diabetes 2019. control study. Pediatr Diabetes 2019. Accepted Author Manuscript. doi:10.1111/pedi.12894