title: Type 1 diabetes in older adults: Comparing treatments and chronic complications in the United States T1D Exchange and the German/Austrian DPV registries.
abstract: OBJECTIVE
  Compare characteristics, therapies and clinical outcomes in older adults with type 1 diabetes in the United States T1D Exchange (T1DX) and German/Austrian Diabetes Patienten Verlaufsdokumentation (DPV) registries.
  
  
  METHODS
  Cross-sectional study of adults ≥60years old with type 1 diabetes seen in 2011-2012 in the T1DX (n=1283) and DPV (n=2014) registries. Wilcoxon rank-sum test was used for continuous variables and chi-square test for categorical variables. Adjusted analyses used generalized linear models.
  
  
  RESULTS
  Individuals in both registries were similar in body mass index (mean 27kg/m2), percent with obesity (25%) and gender (48% male). In T1DX there was longer diabetes duration (32.3 vs. 28.8years), greater use of antihypertensive medications (including ACE-I and ARBs; 85% vs. 62%), statins (68% vs. 40%), aspirin (77% vs. 21%), insulin pumps (58% vs. 18%), and less smoking (7% vs. 10%); lower adjusted mean LDL-cholesterol (84 vs. 109mg/dL), and lower adjusted mean systolic and diastolic blood pressures (128 vs. 136 and 68 vs. 74mmHg); fewer myocardial infarctions (6% vs. 9% [99% CI of difference, 1% to 5%]), strokes (2% vs. 8% [3% to 7%]), microvascular complications including microalbuminuria (17% vs. 44% [22% to 32%]) but increased depression (16.1% vs. 8.7%). Adjusted mean HbA1c levels were similar (7.5%, 58mmol/mol).
  
  
  CONCLUSIONS
  Differences between the registries included greater use of antihypertensives, statins and insulin pumps, and fewer chronic complications in the T1DX. Further research is needed to better understand the role of intensive therapy in improving outcomes in older adults with type 1 diabetes.
authors.affiliation: SUNY Upstate Medical University, Syracuse, NY, USA.
authors.forename: Ruth S
authors.initials: RS
authors.lastname: Weinstock
authors.affiliation: Hospital Hietzing, 3rd Medical Department, Vienna, Austria.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Schütz-Fuhrmann
authors.affiliation: Jaeb Center for Health Research, Tampa, FL, USA. Electronic address: T1DStats@jaeb.org.
authors.forename: Crystal G
authors.initials: CG
authors.lastname: Connor
authors.affiliation: University of Ulm, ZIBMT, Institute of Epidemiology and Medical Biometry, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Hermann
authors.affiliation: Stanford University, Palo Alto, CA, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
authors.affiliation: Medical University of Lübeck, Department of Internal Medicine, Lübeck, Germany.
authors.forename: Morten
authors.initials: M
authors.lastname: Schütt
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: Shivani
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Medical University of Innsbruck, Department of Pediatrics, Innsbruck, Austria.
authors.forename: Sabine E
authors.initials: SE
authors.lastname: Hofer
authors.affiliation: Jaeb Center for Health Research, Tampa, FL, USA.
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
authors.affiliation: University of Ulm, ZIBMT, Institute of Epidemiology and Medical Biometry, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001317:Austria; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000453:epidemiology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005858:Germany; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: DPV; Geriatrics; T1D Diabetes Exchange; Type 1 diabetes