Search

Copyright of Der Diabetologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Approximately 40 % of adolescents with type 1 diabetes lose contact with specialty care at transfer to adult care, with a marked increase in risk for poor outcomes. Adolescents showed a 2,5-fold increased risk of an HbA 1c level > 9 % after transfer, compared with adolescents who remained in pediatric care. While the use of modern technologies is rapidly increasing in pediatric diabetology, fewer resources are available to address the rapidly changing digital transformation of type 1 diabetes therapy in adult diabetology, not least because of the large number of patients with type 2 diabetes who require care. Therefore, in the transition from children with type 1 diabetes to adult medicine, disparities in resource provision for training and interpretation of new diabetes technologies now add to the problems that have been known for many years. One possible solution would be the creation of regional treatment centers with pediatric and internal medicine care for people with intensive diabetes therapy and use of diabetes technology, as well as the use of telemedicine capabilities. International comparisons show that in centers where pediatric and internal medicine diabetes teams provide age-appropriate care within the same treatment facility, the transition is much less complicated and people with type 1 diabetes benefit from shared experience in the use of diabetes technologies across the lifespan. However, the implementation of such concepts under the framework of the German health care system requires a rethinking among the involved stakeholders and does not seem promising without pressure from the affected people with type 1 diabetes., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Glargine U300 (Gla-300) is a further development of glargine U100 (Gla-100). Since 2015, Gla-300 has been available in Germany and Austria. We compared patients initiating therapy with Gla-300 with patients starting with Gla-100. Moreover, it was investigated whether patients from real-life diabetes care differ from patients participating in the EDITION clinical study program., Methods: Data are based on the diabetes registries DPV and DIVE. Patients started/switched to Gla-100 or Gla-300 in 2015 were included. Linear regression was applied for bodyweight (BW), BMI, HbA 1C , daily total and basal insulin dose/kgBW and negative binomial regression for severe hypoglycemia. Data were adjusted for age, sex, and diabetes duration., Results: 14,123 patients were identified (Gla-100: 11,397; Gla-300: 2726). Gla-300 patients with T1D were older, T2D patients younger compared to subjects using Gla-100 (both p < 0.0001). In Gla-300 subjects, diabetes duration was longer (both p < 0.0001). Patients started/switched to Gla-300 had a higher BW, a higher BMI and a lower baseline HbA 1C . The rate of severe hypoglycemia was comparable. Total and basal insulin doses/kgBW were higher in patients with Gla-300. DPV/DIVE subjects were older, had a lower BW, and were more frequently male compared to EDITION patients. HbA 1C was higher in T1D patients from DPV/DIVE., Conclusion: Data from the diabetes registries DPV/DIVE indicate differences between Gla-300 and Gla-100 patients at the onset of insulin therapy. This analysis provides additional information to the EDITION clinical study program.

An old dream of patients with type 1 diabetes and medical teams alike is a fully automated insulin therapy. Available sensor-augmented insulin-pumps are able to intervene in insulin therapy by reducing the dose. Aim of several studies is to add an algorithm to the interaction of pump and sensor, so that insulin doses can be regulated fully automatically. Totally closed loop systems are currently not yet available for outpatient use. Hybrid closed loop systems have been approved in the US. They can improve the metabolic status of patients with type 1 diabetes. Risks are similar to sensor-augmented insulin-pump therapy. Patients' detailed education will continue to be essential for success., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Due to the variety of affected organ systems, necessitating a multidisciplinary and interconnected approach in deciding on individual diagnostic and therapeutic strategies, a structured documentation of data for patients suffering from diabetes mellitus is steadily gaining importance. Towards this purpose, multiple quality initiatives (e. g. SWEET, QS-DPV, EUBIROD etc.) as well as several software systems (e. g. [DPV2] DIAMAX, DPV, EMIL, Qmax etc.) have been developed to capture patient-related data. This is further complicated by the necessity to exchange data with a large variety of doctor's office administration systems., Methods: To address this complex of issues, DiabetesDE in cooperation with several societies, doctor's associations and prospective end users launched a national register platform. DIVE (Diabetes Care Evaluation) is aimed at establishing a national diabetes register to centrally capture data from diabetes patients being treated by diabetology specialists in Germany, thus making them available for quality assurance and health services research., Results: Since September 2011, 142 so far participating doctors have documented data for 84,774 patients. Compared to patients treated by general practitioners, persons under specialist care show a more advanced clinical picture with substantial co-morbidity., Conclusion: DIVE provides a national platform which will address essential fields of activity with regard to the development of a national diabetes strategy--epidemiology, diabetes registry, health care research, quality assurance--based on usual office administration systems, thus contributing to the improvement of care and treatment for patients suffering from diabetes., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Parents are responsible for the therapy and prognosis of their child with diabetes. Thus a structured initial education covering medical and psychosocial aspects of diabetes for parents offered by a multidisciplinary paediatric diabetes team is essential., Methods: Quality of educational process and outcomes were assessed in 10 German paediatric diabetes units with parents of 81 children (4-14 yrs). A structured diabetes education programme for parents was used. Outcome parameters were parental satisfaction with education, diabetes knowledge (DWT: Typ1), children's quality of metabolic control and health related quality of life (QoL) (KINDL-R) and both parents' well-being (WHO-5) at onset (t0) and 6 (t1) and 12 (t2) months later., Results: On average 30.6 ± 10.1 lessons were required. Parents were highly satisfied with the education. Their diabetes knowledge at t0 and t1 exceeded the T-norms of the best educated adult patients. Children's QoL at t1 and t2, assessed by their parents, didn't differ from representative healthy norms. Mean HbA1c at t1 was 6.8 ± 1.0% and 7.2 ± 1.2% at t2. Compared to standard values of WHO-5 mothers' psychological well-being was poor. Scores < 13 (indicating depression) were seen at 50% (t0), 41% (t1) and 29% (t2) of the mothers., Discussion: The comprehensive diabetes education leads to high levels of diabetes knowledge and satisfaction with care. 12 months after diabetes onset the target of metabolic control (HbA1c < 7.5%) was met by 71% of the children, while their QoL was good. However, the great psychological burden of mothers at onset indicates their need for ongoing specialized care., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Monogenic forms of diabetes are often diagnosed by chance, due to the variety of clinical presentation and limited experience of the diabetologists with this kind of diabetes. Aim of this study was to evaluate clinical parameters for an efficient screening., Methods: Clinical parameters were: negative diabetes-specific antibodies at onset of diabetes, positive family history of diabetes, and low to moderate insulin requirements after one year of diabetes treatment. Molecular testing was performed through sequencing of the programming regions of HNF-4alpha (MODY 1), glucokinase (MODY 2) and HNF-1alpha/TCF1 (MODY 3) and in one patient the HNF-1beta/TCF2 region (MODY 5). 39 of 292 patients treated with insulin were negative for GADA and IA2A, and 8 (20.5%) patients fulfilled both other criteria., Results: Positive molecular results were found in five (63%) patients (two with MODY 2, two with MODY 3, one with MODY 5). At diabetes onset, the mean age of the 5 patients with MODY was 10.6 ± 5.3 yrs (range 2.6-15 yrs), HbA(1c) was 8.4 ± 3.1 % (6.5-13.9%), mean diabetes duration until diagnosis of MODY was 3.3 ± 3.6 yrs (0.8-9.6 yrs) with insulin requirements of 0.44 ± 0.17 U/kg/d (0.2-0.6 U/kg/d). Patients with MODY 3 were changed from insulin to repaglinide, those with MODY 2 were recommended discontinuing insulin treatment., Conclusion: In patients with negative diabetes-specific antibodies at onset of diabetes, with a positive family history, and low to moderate insulin needs a genetic screening for MODY is indicated. Watchful consideration of these clinical parameters may lead to an early genetic testing, and to an adequate treatment., (© Georg Thieme Verlag KG Stuttgart · New York.)

Type 1 diabetes (T1D) is the most common metabolic disease in childhood with an increasing incidence of about 3 to 5% per year, particularly in preschool children. Despite substantial progresses in diabetes research concerning its pathogenesis and etiology in the last decades, there is no strategy for primary prevention in subjects with subclinical signs of diabetes. Nowadays, it is well-known that T1D is caused by partial or total destruction of pancreatic islet cells, resulting in progressive incapacity to produce insulin. This inflammation is of an autoimmune nature, resulting both from environmental and genetic influences. Children with T1D usually have a several day history of typical symptoms such as frequent urination, excessive thirst and weight loss, which appear when about 80% of the pancreatic beta cells are already destroyed. If those symptoms are misinterpreted, the continuing hyperglycaemic metabolism leads to a potential life-threatening condition the diabetic ketoacidosis. Patients with T1D require daily subcutaneous injections of insulin, with the overall aim to mimic the physiological release of insulin during meal-associated and fasting periods (intensive insulin therapy). The most important parameters to evaluate the effectiveness of insulin treatment are blood glucose monitoring and HbA1c. The increased availability of systems for continuous glucose monitoring may help patients to have a better insight into their metabolic conditions. Sensor-based insulin treatment is likely to have a significant impact on paediatric diabetes therapy and education in the future.

Background and Objective: To investigate the burden and the financial and professional consequences for mothers and fathers after the onset of diabetes in their child in relationship to age at onset and family structure., Patients and Methods: All families of children with an age at onset < 14 years and a diabetes duration < 10 years treated at four large pediatric diabetes centers received a structured questionnaire (burden of diabetes, professional position and career development, financial consequences for both parents, demographic data)., Results: 580 families with 583 children with type 1 diabetes (46 % girls, diabetes duration 5.0 +/- 3.2 years, age at onset 6.9 +/- 3.9 years) participated. 42 % of the children had an age at onset below 6 years. 11 % had single parents. Before the onset of diabetes in their children 93 % of the fathers worked full-time, thereafter 4 % changed their employment. Mothers worked at onset full-time in 22 % and part-time in 38 %; thereafter 31 % reduced their working time or stopped working. 33 % of the mothers reported handicaps in their professional career development, especially those with a child with age at onset below 6 years (44 %). Negative financial consequences were present in 44 % of the families. The day to day burden on a scale from 1 to 5 decreased both in mothers and in fathers with increasing age at onset. The individual burden was higher in mothers (3.6 +/-1.1) than in fathers (2.8 +/- 1.1) (p = 0.000)., Conclusions: Initiatives to reduce the burden on families with a child with diabetes are urgently needed. Particularly the social and professional integration of mothers with younger children at diabetes onset need to be improved through support measures outside the family.

Coeliac disease (CD) and autoimmune thyreoiditis (AIT) are associated with type-1 diabetes. These diseases frequently occur without apparent clinical symptoms. Therefore, a serological screening by autoantibody testing is required for early detection. Identified by screening, the prevalence of CD and AIT is reported to be up to 10-fold higher in young patients with type-1 diabetes than in healthy children. Up to now, no uniform recommendations exist regarding a standardized screening procedure as well as the treatment of patients with clinically asymptomatic disorder and evidence of autoimmunity. A delay in the detection of associated diseases, however, may lead to clinical relevant, but otherwise preventable complications.