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Diabetologia

, Volume 57, Issue 8, pp 1578–1585 | Cite as

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 A. DiMeglio
  • Birgit Rami-Merhar
  • Roy W. Beck
  • Edith Schober
  • William V. Tamborlane
  • Thomas M. Kapellen
  • Reinhard W. Holl
  • for the DPV Initiative and the T1D Exchange Clinic Network
Article

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 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.

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.

Keywords

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

Abbreviations

CGM

Continuous glucose monitor

DKA

Diabetic ketoacidosis

DPV

Prospective Diabetes Follow-up Registry

IRB

Institutional review board

ISPAD

International Society for Pediatric and Adolescent Diabetes

SH

Severe hypoglycaemia

SMBG

Self-monitoring of blood glucose

T1DX

T1D Exchange

TDI

Total daily insulin

Notes

Acknowledgements

A list of clinical sites in the T1DX and DPV registries contributing data to this manuscript can be found in ESM Text 1 and ESM Text 2.

Funding

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.

Contribution statement

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.

Supplementary material

125_2014_3272_MOESM1_ESM.pdf (9 kb)
ESM Fig. 1 (PDF 9 kb)
125_2014_3272_MOESM2_ESM.pdf (115 kb)
ESM Text 1 (PDF 114 kb)
125_2014_3272_MOESM3_ESM.pdf (10 kb)
ESM Text 2 (PDF 10 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • David M. Maahs
    • 1
  • Julia M. Hermann
    • 2
  • Stephanie N. DuBose
    • 3
  • Kellee M. Miller
    • 3
  • Bettina Heidtmann
    • 4
  • Linda A. DiMeglio
    • 5
  • Birgit Rami-Merhar
    • 6
  • Roy W. Beck
    • 3
  • Edith Schober
    • 6
  • William V. Tamborlane
    • 7
  • Thomas M. Kapellen
    • 8
  • Reinhard W. Holl
    • 2
  • for the DPV Initiative and the T1D Exchange Clinic Network
  1. 1.Barbara Davis Centre for Childhood DiabetesAuroraUSA
  2. 2.Department of Epidemiology and Medical BiometryUniversity of Ulm, ZIMBTUlmGermany
  3. 3.Jaeb Centre for Health ResearchTampaUSA
  4. 4.Catholic Children’s Hospital Wilhelmstift HamburgHamburgGermany
  5. 5.Department of Endocrinology/DiabetologyIndiana University School of MedicineIndianapolisUSA
  6. 6.Department of PediatricsMedical University of ViennaViennaAustria
  7. 7.Department of Paediatric Endocrinology, Yale School of MedicineYale UniversityNew HavenUSA
  8. 8.Women and Children’s CentreUniversity of LeipzigLeipzigGermany

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