title: 20 Years of Pediatric Benchmarking in Germany and Austria: Age-Dependent Analysis of Longitudinal Follow-Up in 63,967 Children and Adolescents with Type 1 Diabetes.
abstract: BACKGROUND
  To investigate changes in diabetes treatment over the last two decades in three age-groups of children and adolescents with type 1 diabetes (T1D) from Germany and Austria.
  
  
  METHODS
  63,967 subjects (<18yr) with T1D documented between 1995 and 2014 from the DPV-database were included and stratified according to age (0.5-<6, 6-<12, 12-<18yr). Regression models were applied for insulin regimens (<3 and ≥4 injection time points/day, or continuous subcutaneous insulin infusion (CSII)), use of rapid- and long acting insulin analogues, NPH insulin, and frequency of self-monitoring of blood glucose (SMBG)/day. Models were adjusted for sex, diabetes duration, and migration background. P-value for trend was given.
  
  
  RESULTS
  The number of subjects with <3 injection time points/day decreased from 1995 to 2014 to <5% in all age-groups (p<0.0001). Proportion of patients with ≥4 injections/day increased until the early 2000s, and then declined until 2014. This trend was not found in 6-<12yr olds (p = 0.3403). CSII increased in all age-groups (p<0.0001) with the highest increase in children <6 years (from 0.4% to 79.2%), and the lowest increase in 12-<18 year olds (from 1.0% to 38.9%). NPH insulin decreased in all age-groups (p<0.0001). Insulin analogues, especially rapid-acting, became more frequent in all age-groups (p<0.0001), accounting for 78.4% in 2014 for all subjects. The highest use was found in the youngest children (in 2014: 85.6%), the lowest use in 6-<12 year olds (in 2014: 72.9%). The number of SMBG/day increased from 2.2 to 6.4 with a similar rise in all age-groups (p<0.0001). Frequency was highest in subjects <6yr.
  
  
  CONCLUSIONS
  In all age-groups, T1D treatment was intensified over the last 20 years. Age-specific differences in trends were particularly observed in the number of patients on CSII, in the number of patients with 4 or more injections/day, and in the frequency of SMBG/day.
authors.affiliation: Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.|German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bohn
authors.affiliation: Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Aachen, Germany.|Department of Gynecological Endocrinology and Reproductive Medicine, Medical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Aachen, Germany.|Department of Pediatrics, Bethlehem Hospital, Stolberg, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Karges
authors.affiliation: Department of Pediatrics, Endocrinology and Diabetology, Clinic Chemnitz, Chemnitz, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Vogel
authors.affiliation: Center for Pediatrics and Adolescents Medicine, Neonatology and Pediatric intensive care, Clinic Itzehoe, Itzehoe, Germany.
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Otto
authors.affiliation: Center for Pediatrics and Adolescent Medicine, Bremen-Mitte Hospital, Bremen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Marg
authors.affiliation: Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Sabine E
authors.initials: SE
authors.lastname: Hofer
authors.affiliation: Department of Pediatrics, Medical University of Graz, Graz, Austria.
authors.forename: Elke
authors.initials: E
authors.lastname: Fröhlich-Reiterer
authors.affiliation: Department of Pediatric Endocrinology and Diabetology, Olgahospital, Stuttgart Clinical Center, Stuttgart, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Holder
authors.affiliation: Department of Pediatric Endocrinology and Diabetology, University Hospital Bonn, Bonn, Germany.
authors.forename: Michaela
authors.initials: M
authors.lastname: Plamper
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, University Hospital for Children and Adolescents, Ulm, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Wabitsch
authors.affiliation: Centre of Diabetes and Metabolic Disorders, Karlsburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kerner
authors.affiliation: Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.|German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001317:Austria; D019985:Benchmarking; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007223:Infant; D007328:Insulin / Q000008:administration & dosage* / Q000031:analogs & derivatives; D007332:Insulin Infusion Systems / Q000639:trends; D049528:Insulin, Long-Acting / Q000008:administration & dosage; D008137:Longitudinal Studies; D008297:Male
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting