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Auzanneau, M.* ; Lanzinger, S.* ; Bohn, B.* ; Kroschwald, P.* ; Kuhnle-Krahl, U.* ; Holterhus, P.M.* ; Placzek, K.* ; Hamann, J.* ; Bachran, R.* ; Rosenbauer, J.* ; Maier, W.

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.

Diabetes Care 41, 2517-2525 (2018)
Verlagsversion Postprint Forschungsdaten DOI PMC
Open Access Green
OBJECTIVEThis study analyzed whether area deprivation is associated with disparities in health care of pediatric type 1 diabetes in Germany.RESEARCH DESIGN AND METHODSWe selected patients <20 years of age with type 1 diabetes and German residence documented in the "diabetes patient follow-up" (Diabetes-Patienten-Verlaufsdokumentation [DPV]) registry for 2015/2016. Area deprivation was assessed by quintiles of the German Index of Multiple Deprivation (GIMD 2010) at the district level and was assigned to patients. To investigate associations between GIMD 2010 and indicators of diabetes care, we used multivariable regression models (linear, logistic, and Poisson) adjusting for sex, age, migration background, diabetes duration, and German federal state.RESULTSWe 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 HbA(1c) 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.CONCLUSIONSArea 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.
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Publikationstyp Artikel: Journalartikel
Dokumenttyp Wissenschaftlicher Artikel
Korrespondenzautor
Schlagwörter Socioeconomic-status; Glycemic Control; Multiple Deprivation; Children; Adolescents; Hypoglycemia; Health; Care; Impact; Level
ISSN (print) / ISBN 0149-5992
e-ISSN 1935-5548
Zeitschrift Diabetes Care
Quellenangaben Band: 41, Heft: 12, Seiten: 2517-2525 Artikelnummer: , Supplement: ,
Verlag American Diabetes Association
Verlagsort Alexandria, Va.
Nichtpatentliteratur Publikationen
Begutachtungsstatus Peer reviewed
Institut(e) Institute of Health Economics and Health Care Management (IGM)