title: Impact of Maternal Country of Birth on Type-1-Diabetes Therapy and Outcome in 27,643 Children and Adolescents from the DPV Registry.
abstract: OBJECTIVE
  To study the impact of maternal country of birth on type-1-diabetes (T1D) therapy and outcome.
  
  
  METHODS
  27,643 T1D patients aged ≤20 years with documented maternal country of birth from the multicenter German/Austrian diabetes patient registry (DPV) were analyzed. Patients were categorized based on their mother's origin: Germany/Austria (reference), Turkey, Southern Europe, and Eastern Europe. To compare BMI standard deviation score (BMI-SDS), diabetes therapy and outcome between groups, multivariable regression was applied with adjustments for age, sex and duration of diabetes. Based on observed marginal frequencies, adjusted estimates were calculated. Linear regression was used for continuous data, logistic regression for binary data and Poisson regression for count data. All statistical analyses were performed using SAS 9.4. Significance was set at a two-tailed p<0.05.
  
  
  RESULTS
  83.3% of patients were offspring of native mothers. A Turkish, Southern or Eastern European background was documented in 2.4%, 1.7% and 4.3% of individuals. After demographic adjustment, patients with migration background had a higher mean BMI-SDS (Turkey, Southern Europe or Eastern Europe vs. Germany/Austria: 0.58±0.03, 0.40±0.04, or 0.37±0.02 vs. 0.31±0.01; ±SE) and a lower use of insulin pumps (26.8%, 27.9%, or 32.6% vs. 37.9%) compared to offspring of native mothers. Mean HbA1c was worst in individuals of Turkish mothers (Turkey vs. Germany/Austria: 69.7±0.7 vs. 66.6±0.1 mmol/mol; ±SE). Patients of Eastern European descent had an increased rate of severe hypoglycemia (22.09±0.13 vs. 16.13±0.02 events per 100 patient-years) and ketoacidosis was more prevalent in offspring of Turkish or Southern European mothers (7.50±0.10, or 7.13±0.11 vs. 6.54±0.02 events per 100 patient-years). Patients of Turkish descent were more often hospitalized (57.2±2.7 vs. 48.5±0.4 per 100 patient-years). All differences were significant.
  
  
  CONCLUSIONS
  The differences in diabetes therapy and outcome among patients with distinct migration background suggest that specific challenges have to be considered in clinical care.
authors: Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, German Center for Diabetes Research (DZD), Ulm, Germany.
authors: Nicole
authors: N
authors: Scheuing
authors: Department of Pediatric Endocrinology and Diabetology, Charité Universitätsmedizin, Berlin, Germany.
authors: Susanna
authors: S
authors: Wiegand
authors: Institute for Biometrics and Epidemiology, German Diabetes Center, German Center for Diabetes Research (DZD), Düsseldorf, Germany.
authors: Christina
authors: C
authors: Bächle
authors: Department of Pediatrics, Medical University of Graz, Graz, Austria.
authors: Elke
authors: E
authors: Fröhlich-Reiterer
authors: Department of Pediatrics and Adolescent Medicine, Protestant Hospital Oberhausen, Oberhausen, Germany.
authors: Eva
authors: E
authors: Hahn
authors: Institute for Biometrics and Epidemiology, German Diabetes Center, German Center for Diabetes Research (DZD), Düsseldorf, Germany; Department of Public Health, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors: Andrea
authors: A
authors: Icks
authors: Clinic for Children and Adolescent Medicine, Mutterhaus der Borromäerinnen, Trier, Germany.
authors: Karl-Heinz
authors: KH
authors: Ludwig
authors: Children's Hospital, Hospitals of the City of Cologne, Cologne, Germany.
authors: Kirsten
authors: K
authors: Mönkemöller
authors: Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.
authors: Oliver
authors: O
authors: Razum
authors: Institute for Biometrics and Epidemiology, German Diabetes Center, German Center for Diabetes Research (DZD), Düsseldorf, Germany.
authors: Joachim
authors: J
authors: Rosenbauer
authors: Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, German Center for Diabetes Research (DZD), Ulm, Germany.
authors: Reinhard W
authors: RW
authors: Holl
mesh_terms: D000293:Adolescent; D001317:Austria; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000208:ethnology; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000188:drug therapy* / Q000208:ethnology; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005006:Ethnicity; D005060:Europe; D005061:Europe, Eastern; D005260:Female; D005858:Germany; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000188:drug therapy* / Q000208:ethnology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007223:Infant; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome; D014421:Turkey; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human