Regional Disparities in Diabetes Care for Pediatric Patients with Type 1 Diabetes. A Cross-sectional DPV Multicenter Analysis of 24 928 German Children and Adolescents

B. Bohn; J. Rosenbauer; A. Icks; C. Vogel; P. Beyer; H. Rütschle; U. Hermann; P. M. Holterhus; V. Wagner; S. von Sengbusch; K. Fink; R. W. Holl; for the DPV initiative

doi:10.1055/s-0042-101159

Experimental and Clinical Endocrinology & Diabetes, Table of Contents

Exp Clin Endocrinol Diabetes 2016; 124(02): 111-119
DOI: 10.1055/s-0042-101159

Article

Regional Disparities in Diabetes Care for Pediatric Patients with Type 1 Diabetes. A Cross-sectional DPV Multicenter Analysis of 24 928 German Children and Adolescents

Authors

B. Bohn

¹Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
J. Rosenbauer

²Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany
A. Icks

²Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany

³Department of Public Health, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
C. Vogel

⁴Children’s Hospital Chemnitz, Chemnitz, Germany
P. Beyer

⁵Clinic for Pediatrics, Protestant Hospital, Oberhausen, Germany
H. Rütschle

⁶Pediatric Diabetes Practice, Mutterstadt, Germany
U. Hermann

⁷Pediatric Diabetes Practice, Reutlingen, Germany
P. M. Holterhus

⁸Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Kiel/Christian-Albrechts University of Kiel, Kiel, Germany
V. Wagner

⁹Pediatric Practice, Rostock, Germany
S. von Sengbusch

¹⁰Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, University of Lübeck, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
K. Fink

¹Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
R. W. Holl

¹Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany

for the DPV initiative

Abstract

Background: Data on regional differences in the quality of medical care in Germany are scarce. This study aimed to compare outcome quality and medical treatment of pediatric patients with type 1 diabetes between the federal states of Germany.

Methods: 24 928 patients (< 18 years of age) with type 1 diabetes and German residence were selected from the Diabetes-Patienten-Verlaufsdokumentation database. Indicators of outcome quality were HbA_1C, overweight prevalence, and rate of severe hypoglycemia. To reflect medical treatment, use of insulin pumps and use of rapid-acting or long-acting insulin analogues were analyzed. Logistic regression models were created for binary variables with federal state as independent predictor. Linear regression was applied for HbA_1C and Poisson regression for rate of severe hypoglycemia. Confounders: Sex, age, diabetes duration, migratory background.

Results: Disparity was observed for indicators of outcome quality between the 16 federal states of Germany (all p<0.05). After adjustment, HbA_1C varied between 55.8 mmol/mol and 67.3 mmol/mol, overweight prevalence between 10.0 and 15.3%, severe hypoglycemia ranged from 0.06 events/PY to 0.21 events/PY. Overall, the best outcome quality appeared to be present in Saxony. Medical treatment also differed. The percentage of pediatrics on insulin pumps varied between 26.3 and 51.8%. The use of rapid-acting analogues ranged from 56.6 to 96.2% and the use of long-acting analogues varied between 41.9 and 96.9% (all p<0.0001).

Conclusions: Medical treatment and outcome quality in pediatrics with type 1 diabetes differed within Germany. Disparities in individual socioeconomic status, regional deprivation, or differences in medical reimbursement decisions might have contributed to the patterns observed.

Key words

type 1 diabetes - children and adolescents - regional differences - federal states of Germany - outcome quality - medical treatment

Full Text

References

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