Area Deprivation and Regional Disparities in Treatment and Outcome Quality of 29,284 Pediatric Patients With Type 1 Diabetes in Germany: A Cross-sectional Multicenter DPV Analysis

Autor: Rainer Bachran, Peter Kroschwald, Werner Maier, Stefanie Lanzinger, Johannes Hamann, Joachim Rosenbauer, Paul Martin Holterhus, Kerstin Placzek, Barbara Bohn, Ursula Kuhnle-Krahl, Marie Auzanneau, Dpv Initiative
Přispěvatelé: European Union (EU), Horizon 2020
Jazyk: angličtina
Předmět:
Research design
Male
Cross-sectional study
Endocrinology
Diabetes and Metabolism
medicine.medical_treatment
Kind
Overweight
Health Services Accessibility
Regional disparities
0302 clinical medicine
Medizinische Versorgung
Diabetes mellitus
Type 1
Germany
Outcome Assessment
Health Care
Area deprivation
030212 general & internal medicine
Registries
Child
Geography
Diabetes mellitus Typ 1
Severe hypoglycemia
3. Good health
Type 1 diabetes
Treatment Outcome
Female
medicine.symptom
medicine.medical_specialty
Children and adolescents
Adolescent
Healthcare disparities
030209 endocrinology & metabolism
03 medical and health sciences
Internal medicine
Diabetes mellitus
Internal Medicine
medicine
Humans
ddc:610
Healthcare Disparities
Quality of Health Care
Advanced and Specialized Nursing
business.industry
Insulin
medicine.disease
Cross-Sectional Studies
Diabetes Mellitus
Type 1
Jugend
business
Regionale Verteilung
Zdroj: Diabetes Care
Diabetes Care 41, 2517-2525 (2018)
ISSN: 1935-5548
0149-5992
DOI: 10.2337/dc18-0724
Popis: OBJECTIVE This study analyzed whether area deprivation is associated with disparities in health care of pediatric type 1 diabetes in Germany. RESEARCH DESIGN AND METHODS We selected patients RESULTS We analyzed data from 29,284 patients. From the least to the most deprived quintile, use of continuous glucose monitoring systems (CGMS) decreased from 6.3 to 3.4% and use of long-acting insulin analogs from 80.8 to 64.3%, whereas use of rapid-acting insulin analogs increased from 74.7 to 79.0%; average HbA1c increased from 7.84 to 8.07% (62 to 65 mmol/mol), and the prevalence of overweight from 11.8 to 15.5%, but the rate of severe hypoglycemia decreased from 12.1 to 6.9 events/100 patient-years. Associations with other parameters showed a more complex pattern (use of continuous subcutaneous insulin infusion [CSII]) or were not significant. CONCLUSIONS Area deprivation was associated not only with key outcomes in pediatric type 1 diabetes but also with treatment modalities. Our results show, in particular, that the access to CGMS and CSII could be improved in the most deprived regions in Germany.
Databáze: OpenAIRE
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