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Background To prevent the potentially life-threatening complication, diabetic ketoacidosis (DKA) at type 1 diabetes onset in children and adolescents, awareness campaigns can lead to a significant reduction of DKA. As in Germany, the incidence of DKA at diabetes onset had remained at a constant rate over the last 15 years and increasing numbers of very young children present with higher risk for DKA we decided to set up the Stuttgart Ketoacidosis Awareness Campaign. Methods Over 3 years (2015-2017) the campaign was conducted using information flyers and posters illustrating the typical symptoms of diabetes at school entry health examinations at the Public Health Department, in day-care facilities, in all pediatric practices and by regular public activities. The period between 2011 and 2013 was selected as a reference period. Results Approximately 17 000 children, median age 4.5 years, and their families were informed about the campaign during the preschool health examination. A total of 118 children and adolescents were treated with newly diagnosed type 1 diabetes compared with 127 during the reference period. During the campaign the incidence of DKA decreased significantly from 28% to 16%. Conclusions Awareness campaigns like the Stuttgart Ketoacidosis Awareness Campaign about the typical clinical symptoms of type 1 diabetes can significantly reduce the risk for DKA at diabetes onset. Important factors for the success of our campaign were the close cooperation between the children's hospital and the public health department, the targeted approach of families, teachers, and pediatricians and the duration of the campaign over 3 years.

Background Diabetes and prediabetes are defined based on different methods such as fasting glucose, glucose at 2-hour in oral glucose tolerance test (OGTT), and glycated hemoglobin A1c (HbA1c). These parameters probably describe different deteriorations in glucose metabolism limiting the exchange between each other in definitions of diabetes. Objective To investigate the relationship between OGTT and HbA1c in overweight and obese children and adolescents living in Germany. Methods Study population: Overweight and obese children and adolescents (n = 4848; 2668 female) aged 7 to 17 years without known diabetes. The study population was stratified into the following subgroups: normal glucose tolerance, prediabetes, diabetes according to OGTT and/or HbA1c categories, confirmed diagnosis of diabetes. Results In the entire study group fasting plasma glucose (FPG) correlated weakly to 2-hour glucose (r = 0.26), FPG correlated weakly to HbA1c (r = 0.18), and 2-hour glucose correlated weakly to HbA1c (r = 0.17, all P

Objective of this study was to analyze prevalence changes in type 2 diabetes (T2D) among children and adolescents over the last 10 years. We performed a cross-sectional survey in Baden-Wurttemberg (BW), Germany, by using a written questionnaire and comparing these results with T2D prevalence data from the same area retrieved in 2004/2005. In 2016, 50 patients with T2D under 20 years of age were registered in BW, Germany, which corresponds to a prevalence rate of 2.42 per 100 000 (95% confidence interval [CI]: 1.75-3.09). The prevalence rate found in the same geographic area 10 years prior was 2.30 per 100 000 (95% CI: 1.70-2.90). Overall, 70% of T2D patients of this age group were treated by adult diabetologists. Concisely the prevalence of T2D in children and adolescents is still low in South Germany, remaining practically unchanged over the past decade.

Diabetes and prediabetes are defined based on different methods such as fasting glucose, glucose at 2-hour in oral glucose tolerance test (OGTT), and glycated hemoglobin A1c (HbA1c). These parameters probably describe different deteriorations in glucose metabolism limiting the exchange between each other in definitions of diabetes.To investigate the relationship between OGTT and HbA1c in overweight and obese children and adolescents living in Germany.Study population: Overweight and obese children and adolescents (n = 4848; 2668 female) aged 7 to 17 years without known diabetes. The study population was stratified into the following subgroups: normal glucose tolerance, prediabetes, diabetes according to OGTT and/or HbA1c categories, confirmed diagnosis of diabetes.In the entire study group fasting plasma glucose (FPG) correlated weakly to 2-hour glucose (r = 0.26), FPG correlated weakly to HbA1c (r = 0.18), and 2-hour glucose correlated weakly to HbA1c (r = 0.17, all P .001). Patients with confirmed diabetes showed a very high correlation between FPG and 2-hour glucose (r = 0.73, n = 50). Moderate correlations could be found for patients with impaired fasting glucose (2-hour glucose vs HbA1c: r = 0.30, n = 436), for patients with diabetes according to OGTT and/or HbA1c (FPG vs 2-hour glucose: r = 0.43; 2-hour glucose vs HbA1c: r = -0.30, n = 115) and for patients with confirmed diabetes (2-hour glucose vs HbA1c: r = -0.47, all P .001).Because FPG, 2-hour glucose, and HbA1c correlated only weakly we propose that these parameters, particularly in the normal range, might reflect distinct aspects of carbohydrate metabolism.

Background: Since 1987, patients with newly diagnosed diabetes mellitus type 1 under 15 yr of age have been registered in Baden-Wuerttemberg (BW), Germany. Aim: Our aim was to describe the frequency and the clinical presentation of diabetic ketoacidosis (DKA) at onset of type 1 diabetes mellitus in children. Methods: All 31 pediatric departments in BW and one diabetes center participated in this study. Hospital records of 2121 children below 15 yr of age were examined retrospectively. DKA was defined as glucose > 250 mg/dL, pH

Objective: On the basis of 2121 case observations between 1987 and 1997, we describe the clinical and laboratory characteristics of diabetes mellitus type 1 at its onset. Our objective is to analyze whether clinical presentation follows a uniform pattern or whether there is evidence for different subtypes. Research design and methods: Thirty-one pediatric hospitals and one diabetes center in Baden-Wuerttemberg (BW), Germany, participated in this study. The hospital records of 2121 children below 15 yr of age were examined retrospectively. Statistical analysis was done after logarithmic transformation into a normal distribution. Results: The average duration of symptoms was found to be 15.2 d (95% CI (Confidence Intervals) = 14.3–16.1) ranging between 2.0 and 180 d (95% central range). The most frequent symptoms were polyuria and polydipsia; 7.2% presented with altered level of consciousness. The mean blood glucose value was 407.9 mg/dL (95% CI = 400.0–416.0), corresponding to 23.3 mmol/L (95% CI = 22.8–23.8). The median pH value was 7.35 (95% CI = 7.34–7.36), and the median base excess was −5 mmol/L (95% CI =−5 to −4). The younger patients had a shorter duration of symptoms and suffered most frequently from ketoacidosis. Conclusions: Although the symptoms of diabetes at its onset follow a uniform pattern, the clinical presentation and duration of symptoms indicate that there may be various forms of type 1 diabetes.

Ehehalt S, Dietz K, Willasch AM, Neu A; for the DIARY-Group Baden-Wuerttemberg. Prediction model for the incidence and prevalence of type 1 diabetes in childhood and adolescence: evidence for a cohort-dependent increase within the next two decades in Germany. Objective: To provide data on type 1 diabetes (T1D) epidemiology in childhood over a period of 20 years and to predict prevalence and cohort-age-specific incidence rates (IRs) for the next two decades in Germany. Methods: The Baden-Wuerttemberg Diabetes Incidence Registry (DIARY) includes children and adolescents below 15 years of age with new onset of T1D (period 1987–2006, n = 5108 cases). Results: The mean age- and sex-standardized IR was 15.3/100 000/year (95% CI 14.8–15.7) and the average increase in the IR was 4.4% per year (95% CI 3.9–4.9). Within the next 20 years (2007–2026), the risk for developing diabetes will increase like the square of a linear function with calendar year for all age ranges. There is a strong correlation between the predicted IRs of the cohorts and the observed IRs (n = 300; root mean square error = 0.56; r2 = 0.71) and a negative correlation between mean age at onset and T1D IR (p = 0.02). On 31 December 2006, the prevalence of T1D was 0.126% (95% CI 0.121–0.132). The predicted prevalence (end of 2026) is estimated to be 0.265% (95% CI 0.25–0.28; predicted cases: n = 2950; 95% CI 2900–3000). Conclusions: In comparison to observations made in the past, the risk of disease rises even faster than expected: The younger the child, the quicker the increase of the cohort-age-specific IR and the higher the risk for T1D during lifetime.

Ehehalt S, Gauger N, Blumenstock G, Feldhahn L, Scheffner T, Schweizer R, Neu A for the DIARY-Group Baden-Wuerttemberg. Hemoglobin A1c is a reliable criterion for diagnosing type 1 diabetes in childhood and adolescence. Background: Little is known about the use of the hemoglobin A1C (HbA1c) test for the diagnosis of diabetes in childhood and adolescence. The aim is to investigate sensitivity and specificity of HbA1c at onset of childhood type 1 diabetes. Methods: A total of 184 children and adolescents with blood glucose levels above 200 mg/dL (11.1 mmol/L) were included: 84.8% (n = 156, mean age 9.0 yr) with new onset of type 1 diabetes, 15.2% (n = 28, mean age 6.1 yr) with transient hyperglycemia. HbA1c was measured using the Bayer® DCA2000 analyzer. Results: Patients with new onset of type 1 diabetes (n = 156) had HbA1c values between 6.6% and > 14% (mean (SD) 11.4 (2.0)%; IQR, interquartile range 9.8–13.3%). All patients suffered from typical symptoms of hyperglycemia, i.e., polyuria and polydipsia. In the patient group with transient hyperglycemia (n = 28), HbA1c values were between 4.5 and 6.1% (mean (SD) 5.3 (0.4)%; IQR 5.0–5.6%). None of these patients reported typical symptoms of diabetes. All patients with HbA1c values greater than 6.35% had new onset of type 1 diabetes. Sensitivity of HbA1c at the onset of childhood type 1 diabetes was calculated to be 100%. In patients with HbA1c values less than 6.35%, the diagnosis of type 1 diabetes could be excluded. Thus, specificity of HbA1c as diagnostic criterion was 100%. Conclusions: Childhood type 1 diabetes can be diagnosed and excluded with high reliability by means of HbA1c testing.

Objective: To assess the prevalence of type 2 diabetes mellitus (T2DM) and maturity onset diabetes of the young (MODY) in children and adolescents aged 0−20 yr in Baden-Wurttemberg (BW), Germany, and to compare our results with those from other European countries. Methods: Our study involved every children's hospital (n = 31), each diabetologist in private practice (n = 122), and every internal medicine unit (n = 164) in BW. A written questionnaire and a telephone survey were used to identify children with T2DM and MODY who had been examined at any of these institutions between 2004 and 2005. Population data were drawn from the national census of 1987 and the subsequent annual updates. Results: The prevalence of T2DM for the age range from 0 to 20 yr is 2.30/100 000, whereas the prevalence of MODY in the same age range is 2.39/100 000. The median age of patients with T2DM was 15.8 yr, and 13.9 yr for MODY patients. The majority of patients with either T2DM or MODY were treated in children's hospitals and by consultant diabetologists. A molecular genetic analysis was done to substantiate the clinical diagnosis in less than half of the recruits (14.3% of T2DM and 44.8% of MODY patients). Conclusions: The prevalence of T2DM and MODY is considerably lower than the prevalence of type 1 diabetes. Type 2 diabetes thus continues to be a rare disease in children and adolescents in Germany, as is also the case in other European countries.

Since 1987, patients with newly diagnosed diabetes mellitus type 1 under 15 yr of age have been registered in Baden-Wuerttemberg (BW), Germany.Our aim was to describe the frequency and the clinical presentation of diabetic ketoacidosis (DKA) at onset of type 1 diabetes mellitus in children.All 31 pediatric departments in BW and one diabetes center participated in this study. Hospital records of 2121 children below 15 yr of age were examined retrospectively. DKA was defined as glucose250 mg/dL, pH7.30 or bicarbonate15 mmol/L and ketonuria. Statistical analysis was done after logarithmic transformation.26.3% (n = 558) of all patients presented with DKA. The mean age of these patients was 7.9 yr. The frequency of DKA is higher in girls than in boys (28.9 vs. 23.8%; p = 0.0079). Those aged 0-4 yr suffered most frequently (p0.0001) from ketoacidosis (36.0%). The percentage of DKA in newly diagnosed cases was constant over 10 yr. 23.3% of all patients with DKA presented with an altered level of consciousness; 10.9% of these had clinical signs of coma. No deaths occurred. The proportion of ketoacidosis does not increase concurrently with the number of diabetes manifestations in winter.The proportion of DKA in children with newly diagnosed diabetes mellitus is significant. In particular, children5 yr and girls face an increased risk. DKA may be the result of a particularly aggressive subtype of diabetes.