title: 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.
abstract: OBJECTIVE
  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
  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.
authors.affiliation: Barbara Davis Centre for Childhood Diabetes, Aurora, CO, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
authors.forename: Julia M
authors.initials: JM
authors.lastname: Hermann
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: DuBose
authors.forename: Kellee M
authors.initials: KM
authors.lastname: Miller
authors.forename: Bettina
authors.initials: B
authors.lastname: Heidtmann
authors.forename: Linda A
authors.initials: LA
authors.lastname: DiMeglio
authors.forename: Birgit
authors.initials: B
authors.lastname: Rami-Merhar
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
authors.forename: Edith
authors.initials: E
authors.lastname: Schober
authors.forename: William V
authors.initials: WV
authors.lastname: Tamborlane
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kapellen
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D001317:Austria; D001786:Blood Glucose; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000209:etiology*; D005260:Female; D005858:Germany; D006442:Glycated Hemoglobin; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007223:Infant; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D008297:Male; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome; D014481:United States
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human