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
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The study aimed to compare participant characteristics, treatment modalities and clinical outcomes in registry participants less than 6 years old.
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.
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 HbA1c 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 HbA1c levels.
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.
KeywordsClinical outcomes DPV T1D Exchange Clinic Registry Treatment modalities Type 1 diabetes Young children
Continuous glucose monitor
Prospective Diabetes Follow-up Registry
Institutional review board
International Society for Pediatric and Adolescent Diabetes
Self-monitoring of blood glucose
Total daily insulin
The T1D Exchange is supported through the Leona M. and Harry B. Helmsley Charitable Trust. The DPV is supported through the German BMBF Competence Network Diabetes Mellitus (FKZ 01GI1106).
Duality of interest
DMM, JMH, SND, KMM, BH, LAD, BRM, ES, TMK, RWH declare that they have no duality of interest associated with this manuscript. RWB’s non-profit employer has received consultant payments on his behalf from Sanofi and Animas and a research grant from NovoNordisk with no personal compensation to RWB. WVT has received consulting fees or honorariums from Medtronic and Animas.
DMM and BH researched the data and contributed to data interpretation and the writing of the manuscript. JMH, SND, RWB, WVT and RWH researched the data and contributed to data interpretation, data analysis and the writing of the manuscript. KMM, LAD, BRM and TMK contributed to data interpretation and the writing of the manuscript. ES contributed to data collection in Austria and contributed to data interpretation and the writing of the manuscript. All authors approved the final version.
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