title: Improved metabolic control in children and adolescents with type 1 diabetes: a trend analysis using prospective multicenter data from Germany and Austria.
abstract: OBJECTIVE
  To investigate the temporal trend of metabolic control and potential predictors in German and Austrian children and adolescents with type 1 diabetes.
  
  
  METHODS
  This study is based on a large, multicenter database for prospective longitudinal documentation of diabetes care in Germany and Austria. Data from 30,708 patients documented in 305 diabetes centers between 1995 and 2009 were analyzed. Generalized linear mixed regression models were used to adjust trend analysis for relevant confounders.
  
  
  RESULTS
  Unadjusted mean HbA(1c) decreased from 8.7 ± 1.8% in 1995 to 8.1 ± 1.5% in 2009. In multiple regression analysis, treatment year, age, sex, diabetes duration, migration background, BMI-SDS, and daily insulin dose were significant predictors of metabolic control (P < 0.001). After multiple adjustment, mean HbA(1c) decreased significantly by 0.038% per year (95% CI 0.032-0.043%), average odds ratio (OR) per year for HbA(1c) >7.5% (>9.0%) was 0.969 (95% CI 0.961-0.977) (0.948, 95% CI 0.941-0.956). Intensified insulin regimen was associated with lower frequency of poor metabolic control (HbA(1c) >9%; P = 0.005) but not with average HbA(1c) (P = 0.797). Rate of severe hypoglycemia and hypoglycemic coma decreased significantly (relative risk [RR] per year 0.948, 95% CI 0.918-0.979; RR 0.917, 95% CI 0.885-0.950) over the study period. Diabetic ketoacidosis rate showed no significant variation over time.
  
  
  CONCLUSIONS
  This study showed a significant improvement in metabolic control in children and adolescents with type 1 diabetes during the past decade and a simultaneous decrease in hypoglycemic events. The improvement was not completely explained by changes in the mode of insulin treatment. Other factors such as improved patient education may have accounted for the observed trend.
authors.affiliation: Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany. joachim.rosenbauer@ddz.uni-duesseldorf.de
authors.forename: Joachim
authors.initials: J
authors.lastname: Rosenbauer
authors.forename: Axel
authors.initials: A
authors.lastname: Dost
authors.forename: Beate
authors.initials: B
authors.lastname: Karges
authors.forename: Andreas
authors.initials: A
authors.lastname: Hungele
authors.forename: Anna
authors.initials: A
authors.lastname: Stahl
authors.forename: Christina
authors.initials: C
authors.lastname: Bächle
authors.forename: Eva Maria
authors.initials: EM
authors.lastname: Gerstl
authors.forename: Christian
authors.initials: C
authors.lastname: Kastendieck
authors.forename: Sabine E
authors.initials: SE
authors.lastname: Hofer
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D001317:Austria; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D048909:Diabetes Complications / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D005858:Germany; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy; D007328:Insulin / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin
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