Improved Metabolic Control in Children and Adolescents With Type 1 Diabetes
A trend analysis using prospective multicenter data from Germany and Austria
- Joachim Rosenbauer, MD1⇓,
- Axel Dost, MD2,
- Beate Karges, MD3,
- Andreas Hungele4,
- Anna Stahl, PHD1,
- Christina Bächle, MSC1,
- Eva Maria Gerstl, MD5,
- Christian Kastendieck, MD6,
- Sabine E. Hofer, MD7,
- Reinhard W. Holl, MD4 and
- on behalf of the DPV Initiative and the German BMBF Competence Network Diabetes Mellitus*
- 1Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany
- 2Department of Pediatrics, Friedrich Schiller University of Jena, Jena, Germany
- 3Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
- 4Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
- 5Children’s Hospital, Passau, Germany
- 6Children’s Hospital Bremen North, Bremen, Germany
- 7Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
- Corresponding author: Joachim Rosenbauer, .
OBJECTIVE To investigate the temporal trend of metabolic control and potential predictors in German and Austrian children and adolescents with type 1 diabetes.
RESEARCH DESIGN AND METHODS This study is based on a large, multicenter database for prospective longitudinal documentation of diabetes care in Germany and Austria. Data from 30,708 patients documented in 305 diabetes centers between 1995 and 2009 were analyzed. Generalized linear mixed regression models were used to adjust trend analysis for relevant confounders.
RESULTS Unadjusted mean HbA1c decreased from 8.7 ± 1.8% in 1995 to 8.1 ± 1.5% in 2009. In multiple regression analysis, treatment year, age, sex, diabetes duration, migration background, BMI-SDS, and daily insulin dose were significant predictors of metabolic control (P < 0.001). After multiple adjustment, mean HbA1c decreased significantly by 0.038% per year (95% CI 0.032–0.043%), average odds ratio (OR) per year for HbA1c >7.5% (>9.0%) was 0.969 (95% CI 0.961–0.977) (0.948, 95% CI 0.941–0.956). Intensified insulin regimen was associated with lower frequency of poor metabolic control (HbA1c >9%; P = 0.005) but not with average HbA1c (P = 0.797). Rate of severe hypoglycemia and hypoglycemic coma decreased significantly (relative risk per year [RR] 0.948, 95% CI 0.918–0.979; RR 0.917, 95% CI 0.885–0.950) over the study period. Diabetic ketoacidosis rate showed no significant variation over time.
CONCLUSIONS This study showed a significant improvement in metabolic control in children and adolescents with type 1 diabetes during the past decade and a simultaneous decrease in hypoglycemic events. The improvement was not completely explained by changes in the mode of insulin treatment. Other factors like improved patient education may have accounted for the observed trend.
- Received May 27, 2011.
- Accepted September 24, 2011.
- © 2012 by the American Diabetes Association.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.