title: Lower frequency of insulin pump treatment in children and adolescents of Turkish background with type 1 diabetes: analysis of 21,497 patients in Germany.
abstract: OBJECTIVE
  This study investigated insulin pump therapy in pediatric patients with type 1 diabetes and Turkish origin compared with those without migration background in Germany.
  
  
  METHODS
  Using a nationwide documentation program, we estimated the prevalence of insulin pump therapy in patients < 20 years of age with Turkish origin and those without migration background. Logistic regression was used to adjust for age, sex, diabetes duration, body mass index SD score (BMI-SDS), glycated hemoglobin, number of outpatient visits, number of daily blood glucose self-measurements, and area-based socioeconomic conditions.
  
  
  RESULTS
  In 1,695 pediatric type 1 diabetes patients with Turkish background and 19,802 patients without migration background (respectively: 51.2% and 53.0% boys; mean age, 12.4 ± 4.1 and 12.6 ± 4.2 years; mean diabetes duration, 4.7 ± 3.9 and 5.3 ± 4.0 years), fully adjusted prevalences of insulin pump therapy were 18.5% and 30.9%, respectively (odds ratio 0.51, 95% confidence interval 0.43-0.60, P < 0.001). Age, sex, BMI-SDS, outpatient visits, and blood glucose self-control were significantly associated with the prevalence of insulin pump therapy but did not alter the difference substantially.
  
  
  CONCLUSIONS
  The prevalence of insulin pump therapy is roughly half among pediatric diabetes patients with Turkish background compared with those without migration background. Several covariates could not explain this difference. Individual characteristics or access barriers within the healthcare system may play a role. Further research is needed.
authors.affiliation: Department of Public Health, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany. andrea.icks@ddz.uni-duesseldorf.de
authors.forename: Andrea
authors.initials: A
authors.lastname: Icks
authors.forename: Oliver
authors.initials: O
authors.lastname: Razum
authors.forename: Joachim
authors.initials: J
authors.lastname: Rosenbauer
authors.forename: Christina
authors.initials: C
authors.lastname: Bächle
authors.forename: Andreas
authors.initials: A
authors.lastname: Hungele
authors.forename: Kirsten
authors.initials: K
authors.lastname: Mönkemöller
authors.forename: Esther
authors.initials: E
authors.lastname: Müller-Godeffroy
authors.forename: Bettina
authors.initials: B
authors.lastname: Heidtmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Kapellen
authors.forename: Nicole
authors.initials: N
authors.lastname: Scheuing
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000453:epidemiology / Q000208:ethnology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D007332:Insulin Infusion Systems / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D015995:Prevalence; D014421:Turkey / Q000208:ethnology
chemical_list: D001786:Blood Glucose