Contrasting the clinical care and outcomes of 2,622 children with type 1 diabetes less than 6 years of age in the United States T1D Exchange and German/Austrian DPV registries

David M. Maahs, Julia M. Hermann, Stephanie N. DuBose, Kellee M. Miller, Bettina Heidtmann, Linda DiMeglio, Birgit Rami-Merhar, Roy W. Beck, Edith Schober, William V. Tamborlane, Thomas M. Kapellen, Reinhard W. Holl

Research output: Contribution to journalArticle

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Abstract

Aims/hypothesis: The study aimed to compare participant characteristics, treatment modalities and clinical outcomes in registry participants less than 6 years old. Methods: Participant characteristics, treatment modalities and clinical outcomes (HbA1c, severe hypoglycaemia [SH] and diabetic ketoacidosis [DKA]) as well as frequencies of attaining HbA1c goals in line with the International Society for Pediatric and Adolescent Diabetes (<7.5% [<58 mmol/mol]) and ADA (<8.5% [<69 mmol/mol]) were compared. Results: Insulin pump use was more frequent (74% vs 50%, p<0.001) and HbA1c levels lower in the Prospective Diabetes Follow-up Registry (DPV) than in the T1D Exchange (T1DX) (mean 7.4% vs 8.2%, p<0.001). A lower HbA1c level was seen in the DPV compared with the T1DX for both pump users (p<0.001) and injection users (p<0.001). More children from DPV were meeting the recommended HbA1c goals, compared with children from T1DX (HbA1c <7.5%: 56% vs 22%, p<0.001; HbA1c <8.5%: 90% vs 66%, p<0.001). The adjusted odds of having an HbA 1c level <7.5% or <8.5% were 4.2 (p<0.001) and 3.6 (p<0.001) higher for the DPV than the T1DX, respectively. The frequency of SH did not differ between registries or by HbA1c, whereas the frequency of DKA was higher for the T1DX and greater in those with higher HbA 1c levels. Conclusions/interpretation: DPV data indicate that an HbA1c of <7.5% can frequently be achieved in children with type 1 diabetes who are under 6 years old. An improved metabolic control of type 1 diabetes in young patients appears to decrease the risk of DKA without increasing SH. The greater frequency of suboptimal control in young patients in the T1DX compared with the DPV is not fully explained by a less frequent use of insulin pumps and may relate to the higher HbA1c targets that are recommended for this age group in the USA.

Original languageEnglish
Pages (from-to)1578-1585
Number of pages8
JournalDiabetologia
Volume57
Issue number8
DOIs
StatePublished - 2014

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Diabetic Ketoacidosis
Type 1 Diabetes Mellitus
Hypoglycemia
Registries
Insulin
Age Groups
Injections
Therapeutics

Keywords

  • Clinical outcomes
  • DPV
  • T1D Exchange Clinic Registry
  • Treatment modalities
  • Type 1 diabetes
  • Young children

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

Contrasting the clinical care and outcomes of 2,622 children with type 1 diabetes less than 6 years of age in the United States T1D Exchange and German/Austrian DPV registries. / Maahs, David M.; Hermann, Julia M.; DuBose, Stephanie N.; Miller, Kellee M.; Heidtmann, Bettina; DiMeglio, Linda; Rami-Merhar, Birgit; Beck, Roy W.; Schober, Edith; Tamborlane, William V.; Kapellen, Thomas M.; Holl, Reinhard W.

In: Diabetologia, Vol. 57, No. 8, 2014, p. 1578-1585.

Research output: Contribution to journalArticle

Maahs, DM, Hermann, JM, DuBose, SN, Miller, KM, Heidtmann, B, DiMeglio, L, Rami-Merhar, B, Beck, RW, Schober, E, Tamborlane, WV, Kapellen, TM & Holl, RW 2014, 'Contrasting the clinical care and outcomes of 2,622 children with type 1 diabetes less than 6 years of age in the United States T1D Exchange and German/Austrian DPV registries', Diabetologia, vol. 57, no. 8, pp. 1578-1585. https://doi.org/10.1007/s00125-014-3272-2
Maahs, David M. ; Hermann, Julia M. ; DuBose, Stephanie N. ; Miller, Kellee M. ; Heidtmann, Bettina ; DiMeglio, Linda ; Rami-Merhar, Birgit ; Beck, Roy W. ; Schober, Edith ; Tamborlane, William V. ; Kapellen, Thomas M. ; Holl, Reinhard W. / Contrasting the clinical care and outcomes of 2,622 children with type 1 diabetes less than 6 years of age in the United States T1D Exchange and German/Austrian DPV registries. In: Diabetologia. 2014 ; Vol. 57, No. 8. pp. 1578-1585.
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AU - Maahs, David M.

AU - Hermann, Julia M.

AU - DuBose, Stephanie N.

AU - Miller, Kellee M.

AU - Heidtmann, Bettina

AU - DiMeglio, Linda

AU - Rami-Merhar, Birgit

AU - Beck, Roy W.

AU - Schober, Edith

AU - Tamborlane, William V.

AU - Kapellen, Thomas M.

AU - Holl, Reinhard W.

PY - 2014

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N2 - Aims/hypothesis: The study aimed to compare participant characteristics, treatment modalities and clinical outcomes in registry participants less than 6 years old. Methods: Participant characteristics, treatment modalities and clinical outcomes (HbA1c, severe hypoglycaemia [SH] and diabetic ketoacidosis [DKA]) as well as frequencies of attaining HbA1c goals in line with the International Society for Pediatric and Adolescent Diabetes (<7.5% [<58 mmol/mol]) and ADA (<8.5% [<69 mmol/mol]) were compared. Results: Insulin pump use was more frequent (74% vs 50%, p<0.001) and HbA1c levels lower in the Prospective Diabetes Follow-up Registry (DPV) than in the T1D Exchange (T1DX) (mean 7.4% vs 8.2%, p<0.001). A lower HbA1c level was seen in the DPV compared with the T1DX for both pump users (p<0.001) and injection users (p<0.001). More children from DPV were meeting the recommended HbA1c goals, compared with children from T1DX (HbA1c <7.5%: 56% vs 22%, p<0.001; HbA1c <8.5%: 90% vs 66%, p<0.001). The adjusted odds of having an HbA 1c level <7.5% or <8.5% were 4.2 (p<0.001) and 3.6 (p<0.001) higher for the DPV than the T1DX, respectively. The frequency of SH did not differ between registries or by HbA1c, whereas the frequency of DKA was higher for the T1DX and greater in those with higher HbA 1c levels. Conclusions/interpretation: DPV data indicate that an HbA1c of <7.5% can frequently be achieved in children with type 1 diabetes who are under 6 years old. An improved metabolic control of type 1 diabetes in young patients appears to decrease the risk of DKA without increasing SH. The greater frequency of suboptimal control in young patients in the T1DX compared with the DPV is not fully explained by a less frequent use of insulin pumps and may relate to the higher HbA1c targets that are recommended for this age group in the USA.

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KW - DPV

KW - T1D Exchange Clinic Registry

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