title: Regional Disparities in Diabetes Care for Pediatric Patients with Type 1 Diabetes. A Cross-sectional DPV Multicenter Analysis of 24,928 German Children and Adolescents.
abstract: BACKGROUND
  Data on regional differences in the quality of medical care in Germany are scarce. This study aimed to compare outcome quality and medical treatment of pediatric patients with type 1 diabetes between the federal states of Germany.
  
  
  METHODS
  24,928 patients (< 18 years of age) with type 1 diabetes and German residence were selected from the Diabetes-Patienten-Verlaufsdokumentation database. Indicators of outcome quality were HbA1C, overweight prevalence, and rate of severe hypoglycemia. To reflect medical treatment, use of insulin pumps and use of rapid-acting or long-acting insulin analogues were analyzed. Logistic regression models were created for binary variables with federal state as independent predictor. Linear regression was applied for HbA1C and Poisson regression for rate of severe hypoglycemia. Confounders: Sex, age, diabetes duration, migratory background.
  
  
  RESULTS
  Disparity was observed for indicators of outcome quality between the 16 federal states of Germany (all p<0.05). After adjustment, HbA1C varied between 55.8 mmol/mol and 67.3 mmol/mol, overweight prevalence between 10.0 and 15.3%, severe hypoglycemia ranged from 0.06 events/PY to 0.21 events/PY. Overall, the best outcome quality appeared to be present in Saxony. Medical treatment also differed. The percentage of pediatrics on insulin pumps varied between 26.3 and 51.8%. The use of rapid-acting analogues ranged from 56.6 to 96.2% and the use of long-acting analogues varied between 41.9 and 96.9% (all p<0.0001).
  
  
  CONCLUSIONS
  Medical treatment and outcome quality in pediatrics with type 1 diabetes differed within Germany. Disparities in individual socioeconomic status, regional deprivation, or differences in medical reimbursement decisions might have contributed to the patterns observed.
authors.affiliation: Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Bohn
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Rosenbauer
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Icks
authors.affiliation: Children's Hospital Chemnitz, Chemnitz, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Vogel
authors.affiliation: Clinic for Pediatrics, Protestant Hospital, Oberhausen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Beyer
authors.affiliation: Pediatric Diabetes Practice, Mutterstadt, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Rütschle
authors.affiliation: Pediatric Diabetes Practice, Reutlingen, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Hermann
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Kiel/Christian-Albrechts University of Kiel, Kiel, Germany.
authors.forename: P M
authors.initials: PM
authors.lastname: Holterhus
authors.affiliation: Pediatric Practice, Rostock, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Wagner
authors.affiliation: Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, University of Lübeck, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
authors.forename: S
authors.initials: S
authors.lastname: von Sengbusch
authors.affiliation: Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Fink
authors.affiliation: Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany.
authors.forename: R W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D002648:Child; D003695:Delivery of Health Care; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D005858:Germany; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008962:Models, Theoretical; D011787:Quality of Health Care; D012042:Registries
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human