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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.

Childhood and adolescent overweight and obesity are among the most serious health challenges today. Structured weight reduction programs can be helpful to reduce severe health consequences but evidence is partly scarce. The STARKIDS program aims to improve on some of these limitations and is designed to be a structured, stepwise, digitally supported intervention program for the whole family. It is divided into two intervention steps spanning over 1.5 years and aims at promoting a healthy weight development of children/adolescents with overweight/obesity and an increase in quality of life.The STARKIDS intervention is evaluated in a cluster-randomized study design by comparing it with a control group receiving a one-time structured counselling in the pediatric practice. The study aims to include 1000 families with children/adolescents with overweight/obesity from 100 pediatric practices. The main outcomes are reduction in body mass index percentiles and improvements in children's/adolescent's quality of life, secondary outcomes refer to the contents of the intervention such as diet, physical activity, stress, and media habits. All outcomes are measured on three measurement time points: (T0) at baseline/inclusion in the study, (T1) baseline + 12 months which is the end of step 1 of the STARKIDS intervention, and (T2) baseline + 18 months which is the end of step 2 of the STARKIDS intervention.The stepwise, e-health-supported STARKIDS program is a low-threshold intervention program for families with children/adolescents with overweight/obesity. With the proof of concept, STARKIDS provides the potential to be implemented as a standard care tool for the prevention and intervention of childhood/adolescence obesity in the German health system.German Clinical Trials Register (DRKS) DRKS00022813 (acknowledged primary register of the World Health Organization). Registered on 27 November 2020 (Universal Trial Number U1111-1254-9536).

Type 2 diabetes can occur without any symptoms, and health problems associated with the disease are serious. Screening tests allowing an early diagnosis are desirable. However, optimal screening tests for diabetes in obese youth are discussed controversially. We performed an observational multicenter analysis including 4848 (2668 female) overweight and obese children aged 7 to 17 years without previously known diabetes. Using HbA1c and OGTT as diagnostic criteria, 2.4% (n = 115, 55 female) could be classified as having diabetes. Within this group, 68.7% had HbA1c levels ≥48 mmol/mol (≥6.5%). FPG ≥126 mg/dl (≥7.0 mmol/l) and/or 2-h glucose levels ≥200 mg/dl (≥11.1 mmol/l) were found in 46.1%. Out of the 115 cases fulfilling the OGTT and/or HbA1c criteria for diabetes, diabetes was confirmed in 43.5%. For FPG, the ROC analysis revealed an optimal threshold of 98 mg/dl (5.4 mmol/l) (sensitivity 70%, specificity 88%). For HbA1c, the best cut-off value was 42 mmol/mol (6.0%) (sensitivity 94%, specificity 93%).HbA1c seems to be more reliable than OGTT for diabetes screening in overweight and obese children and adolescents. The optimal HbA1c threshold for identifying patients with diabetes was found to be 42 mmol/mol (6.0%). What is Known: • The prevalence of obesity is increasing and health problems related to type 2 DM can be serious. However, an optimal screening test for diabetes in obese youth seems to be controversial in the literature. What is New: • In our study, the ROC analysis revealed for FPG an optimal threshold of 98 mg/dl (5.4 mmol/l, sensitivity 70%, specificity 88%) and for HbA1c a best cut-off value of 42 mmol/mol (6.0%, sensitivity 94%, specificity 93%) to detect diabetes. Thus, in overweight and obese children and adolescents, HbA1c seems to be a more reliable screening tool than OGTT.

The high prevalence of overweight and obesity in childhood and adolescence call for effective and sustainable intervention strategies. Parental motivation for change may be a key factor in sustained behavioral improvement towards a healthy weight status of their offspring. In this study, we developed a new short instrument to assess parental motivation for change to facilitate motivation-tailored family interventions that promise improved effectiveness. The preexisting gold-standard instrument to assess motivational stages for change was adapted from the self to the parental perspective in a structured multistep Delphi procedure. The new instrument to assess parental motivation for change related to a health problem of their children was psychometrically evaluated in a sample (N = 193) of parents of children or adolescents with overweight or obesity. Confirmatory factor analysis, internal consistency, construct, and criteria validity were analyzed to test the psychometric properties of the new instrument. As a result of the Delphi procedures, all 16 items were successfully transferred to the parental perspective. The hypothesized four-factor structure of the new instrument was approved, and internal consistency and criteria validity were good to very good (albeit with inconsistent findings for the subscale precontemplation). In our investigated target group of parents with children with overweight or obesity, the new instrument to assess parental motivation for change proved to be a practicable, valid, and time-efficient short measure. The new instrument will enable more specific motivational stage-directed interventions that promise higher effectiveness of family-based interventions to fight childhood obesity. However, the subscale precontemplation seemed not fully suitable for the population investigated here and needs to be applied very carefully in future studies.

Obesity is a chronic disease due to the comorbidity associated with it and the need for long-term medical care. Therapeutic intervention is possible at every stage of pathophysiology.The aim of the study is to demonstrate the effect of multimodal lifestyle interventions not only on the BMI/BMI-SDS, but also on (secondary) outcomes such as comorbidities, quality of life as well as the nutritional and movement behavior.The literature database PubMed has been searched for internationally clinical studies on lifestyle interventions among 0 to 18-year-olds with overweight and obesity in the period from 01/01/2009 to 01/01/2016.64 publications with data from 55 studies were included in this overview. Through multimodal lifestyle interventions, many improvements have been achieved in the fields of comorbidity, quality of life, diet and exercise.The use of obesity therapy goes far beyond a weight reduction, which is why other parameters should be regularly recorded as therapeutic targets. Thus the improvement of comorbidities, the quality of life as well as the movement and nutritional behavior for a long-term healthy lifestyle are at least as important and reduce the risk of regain after initial weight reduction.Adipositas ist durch die mit ihr einhergehende Komorbidität und den Bedarf an langfristiger medizinischer Versorgung als chronische Krankheit zu betrachten. Dabei ist auf jeder Stufe der Pathophysiologie eine therapeutische Intervention möglich. Ziel der Arbeit ist es, den Effekt von multimodalen Lebensstilinterventionen nicht nur bezüglich des BMI/BMI-SDS, sondern auch bezüglich (sekundärer) Outcomes wie Komorbiditäten, Lebensqualität sowie des Ernährungs- und Bewegungsverhalten darzustellen.In der Literaturdatenbank PubMed wurde international nach klinischen Studien zu Lebensstilinterventionen bei 0 bis 18-Jährigen mit Übergewicht und Adipositas im Zeitraum vom 01/01/2009 bis 01/01/2016 gesucht.Es sind 64 Publikationen mit Daten aus 55 Studien in die Übersichtsarbeit eingeflossen. Durch multimodale Lebensstilinterventionen konnten vielfältige Verbesserungen in den Bereichen Komorbidität, Lebensqualität, Ernährung und Bewegung erzielt werden.Der Nutzen einer Adipositastherapie geht weit über eine Gewichtsreduktion hinaus, weshalb weitere Parameter als Therapieziele regelhaft erfasst werden sollten. So haben die Verbesserung von Komorbiditäten, der Lebensqualität sowie des Bewegungs- und Ernährungsverhaltens für einen langfristig gesunden Lebensstil eine mind. genauso große Bedeutung und reduzieren die Gefahr des Regains nach einer initialen Gewichtsreduktion.

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.

Aims and Methods: Prediction algorithms suggest factors determining short- and long-term growth response to growth hormone (GH) in Turner’s syndrome (TS). A total of 133 patients (group A; 53% with karyotype 45,X) completed 1 year of treatment and 77 patients (group B) reached adult height (AH) after >4 years on GH treatment. The patients were analysed for factors determining the outcomes, and in addition, the validity of published algorithms was tested. Results: In group A [values are given as medians (10th–90th percentiles)], starting age was 9.4 (4.8–14) years, height was –3.2 (–4.4 to –1.9) SDS (Prader references), and GH dose was 38 (23–48) µg/kg/day. Observed height velocity was 7.7 (5.2–9.8) cm/years and was equal to the predicted height velocity. In group B, projected adult height (PAH) was 147.4 (139.5–154.8) cm. Total gain in height over PAH of 6.1 (2.0–12.6) cm was negatively correlated with height at start, but positively correlated with GH duration, first year Δheight SDS, or index of responsiveness. Observed AH was 153.5 (146.6–160.1) cm and predicted AH was 155.0 (147.4–161.0) cm, which is statistically not different. On GH 2 SDS. Conclusions: The published prediction algorithms were found to be valid. If normal AH is to be reached at the lowest costs and risks, probably only TS children with a good growth potential and a high responsiveness to GH can be treated successfully with GH doses of

To test the feasibility of fat-selective GRE imaging using a spectral-spatial excitation technique for determination of intrahepatic lipid content (IHL) in obese adolescents.Fat-selective MR imaging (1.5 T) was applied to record a single axial slice through a representative liver region within a single breath-hold. The sequence uses six equidistant slice-selective excitation pulses with binomial amplitude ratios to achieve high selectivity for lipid signals after appropriate shimming. IHL(MRI) content was quantified using signal intensity of adjacent subcutaneous adipose tissue. As the gold standard for IHL quantification, single-voxel stimulated echo magnetic resonance spectroscopy (MRS) was applied. IHL(MRS) was quantified using the water peak as a reference.Forty-five MR examinations could be performed, and IHL(MRS) content ranged from 0.7% to 19.1%. Results from MRS and fat-selective imaging correlated well with Spearman coefficients between r = 0.78 and r = 0.86. There were no relevant regional differences in IHL within the liver parenchyma (p0.6359). Fat-selective imaging was able to reliably identify patients with IHL content above 5% with positive/negative likelihood ratio of 11.8 and 0.05, respectively.Fat-selective MR imaging provides both a reliable and a convenient method of rapidly quantifying IHL content in obese adolescents.

BACKGROUND: Sparse data is available on the incidence of endocrine disorders among children in Germany. Aim: A pioneer study was established to analyse, in the German states of Baden-Wuerttemberg (BW) and Bavaria (BY), the incidence and prevalence of congenital adrenal hyperplasia (AGS; CAH), precocious puberty (PP), primary congenital hypothyreosis (PCH), Graves disease (MB), and growth disorders related to the Ullrich-Turner syndrome (UTS) and growth hormone deficiency (GHD). METHODS: Participation in the study involved each paediatric hospital in BW and BY (n=63), and all regional paediatricians belonging to the Association of Statutory Health Insurance Physicians (SHI) practising in these states (n=1 443). Data collection was done from January 1, 2000, to December 31, 2001, and included all patients in the 0

The aim of this study was to analyze changes in adipose tissue (AT) distribution, intrahepatic lipids (IHL), and insulin resistance (IR) among a group of obese adolescents undergoing a 7-months low-level lifestyle intervention. Thirty-nine obese Caucasian adolescents (mean age 13.9 years, body mass index standard deviation score (BMI-SDSLMS) 2.14) were included. AT and IHL were determined by T1-weighted magnetic resonance (MR) imaging and single-voxel MR spectroscopy; IR was estimated using the homeostatic model assessment (HOMA-IR). The lifestyle intervention led to a reduction of both BMI-SDSLMS (boys 2.27 to 2.17; girls 2.00 to 1.82) and HOMA-IR (boys 6.1 to 4.4 (p = 0.008); girls 6.2 to 4.7 (p = 0.030)). IHL dropped in both genders (boys 7.5 to 4.3 %; girls 4.6 to 3.4 %) positively correlating with HOMA-IR (boys r = 0.52; girls r = 0.68), while in contrast visceral AT did not change significantly.Although the lifestyle intervention only slightly reduced BMI-SDSLMS, insulin sensitivity improved in both genders and came along with a marked reduction of IHL. This suggests that IHL might play the dominant role regarding insulin resistance in the youth, especially if compared to other AT compartments such as visceral AT.• MR imaging/spectroscopy can be used to evaluate body fat distribution and intrahepatic lipids in the youth. • The strength of associations between body fat compartments and insulin resistance is under scientific debate.• The study emphasizes that even a low-level lifestyle intervention has a beneficial effect. • The study suggests that intrahepatic lipids are an important factor in the development of insulin resistance.

Objective Our main objective in this study was to identify the type of clinical care received by young type 1 diabetic patients who have made the transition from paediatric to adult care, and to assess the metabolic status of long-term treatment after the transition. Methods A standardized questionnaire was used prospectively to follow 99 patients with type 1 diabetes mellitus after their transition to adult care. This survey was done once a year, from 1998 to 2008. Results Directly after transition from paediatric care 38.4% of patients were found at specialised outpatient units; whereas 41.1% received care at a diabetes centre and 20.5% were monitored by general practitioners or specialists in internal medicine. Five-year results showed that 25.0% had continued to visit an outpatient unit; 41.7% were still visiting a diabetes centre; and 33.3% had remained in the care of general practitioners or internal specialists. We observed a trend showing slight improvements in the HbA1c values over time, however no major changes in metabolic control were observed after transition. Conclusions Transition marks a critical phase for young, diabetic patients as they may frequently switch from one physician or centre to another. The individual optimization of therapy, established during paediatric care, provides the decisive groundwork for disease control in young adults.

Objective: The aim of this study was to identify the prevalence of eating disorder symptoms in obese adolescents participating in a lifestyle intervention for weight loss and to investigate possible relationships with weight change, general psychopathology, and health-related quality of life (HRQOL). Method: At the beginning and after completion of a 6-month lifestyle intervention, 41 participants (20 females; age: 13.7 ± 1.4 years) reported on core symptoms of eating disorders (SCOFF), self-esteem (Rosenberg Self-Esteem Scale, RSES), and HRQOL (Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents, KINDL), while parents filled in a questionnaire assessing their children's internalizing and externalizing behavioral problems (Child Behavior Checklist, CBCL). Results: Compared to age-matched normative samples, patients showed increased behavior problems and an impaired HRQOL. 43% of the patients were screened positive for an eating disorder pathology, and this subgroup showed an increased psychopathological burden compared to patients that were screened negative. The lifestyle intervention resulted in a significant weight loss which was unaffected by the presence of an eating disorder pathology. The screening rate for eating disorders remained stable after the intervention. Conclusion: The large overlap, mutual interaction, and high burden of eating and weight problems in children and adolescents underpin the need for an integrated view in both prevention and treatment approaches in pediatric obesity.

OBJECTIVE To examine the impact of rapidly changing environmental factors on the incidence of type 1 diabetes mellitus (T1D). METHOD We compared the frequency of T1D in children before and after the reunification of Germany by means of the registries of the German Democratic Republic (GDR, 1960-1989) and of Baden-Wuerttemberg (BW, 1987-2006). The number of cases of diabetes onset in East Germany after the reunification was predicted by a mathematical model. The observed incidence rate in the Eastern part of Germany after the reunification was taken from the literature 1. RESULTS In Germany, the incidence rate of T1D in children aged 0-14 was 7.2/100 000/year (95%-CI 6.9-7.5, GDR, 1980-1987), and 10.4/100 000/year (95%-CI 9.5-11.4, BW, 1987-1994). For the whole observation period (1960-2006), the observed incidence rates y could be described by the square of a linear function [GDR: y=(1.86 + 0.040 * (year - 1960))²; r²=0.85; BW: y=(3.03 + 0.085 * (year - 1987))², r²=0.89]. The mean rise in incidence before the reunification was less than half the mean rise after the reunification (mean slope: BW 0.085, 95%-CI 0.080-0.090 vs. GDR 0.040, 95% CI 0.036-0.044). The observed incidence for East Germany after 1989 was higher than the prediction on the basis of the GDR -registry (GDR 12.3/100 000/year vs. Saxony 15.7/100 000/year, 95%-CI 14.2-17.3, n=412; 1999-2003). CONCLUSION We conclude that the basis for the disease progress is a genetic predisposition. Environmental factors may modify changes in incidence of type 1 diabetes but do not determine the overall risk.

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.

Objectives To evaluate 5-slice stack/single-slice MRI approaches and anthropometric measures as predictors for metabolically relevant whole-body adipose tissue (AT) compartments in overweight/obese adolescents. Methods Forty adolescents (22 males, age 11.4–16.1 years) were included with a BMI above the 90th percentile. Volumes of whole-body AT compartments, i.e. total AT (TAT), subcutaneous AT (SCAT) and visceral AT (VAT), were determined using a breath-hold T1-weighted-FSE-MR-sequence and semi-automated segmentation serving as the gold standard. SCAT, VAT and TAT was estimated by either axially oriented single-slices or 5-slice-stacks centred at specific anatomic landmarks (umbilicus, head of femur and humerus). Furthermore, anthropometric measures were also evaluated as predictors of whole-body AT compartments. Results Strong correlations were found for both genders between TAT/SCAT and single-slice evaluation (e.g. whole-body SCAT-SCAT at umbilicus level: r =0.91 (m), r =0.92 (f)) or anthropometry (SCAT-BMI: r =0.93 (m, f)). VAT was correlated to VAT at umbilicus ( r =0.71 (m), r =0.94 (f)) but only weakly to anthropometry. Conclusions Anthropometric measures and single-slice MRI can accurately predict TAT/SCAT which cannot be improved by evaluation of 5-slice stacks. Prediction of VAT by 5-slice stack/single-slice MRI protocols seems only to be accurate in females. Anthropometry cannot be reliably used for prediction of VAT in both genders. Thus, MRI seems to be necessary for quantification of VAT in overweight/obese adolescents of both genders.

Background/Aims: Growth hormone (GH) is an accepted treatment for short children born small for gestational age (SGA). The aim of this analysis was to compare the growth response to GH in children with low birth weight born SGA or appropriate for gestational age (AGA). Methods: This retrospective observational study is from one center. Of all the children with a birth weight Results: [Median; A, B, C, D]: at an age of 4.9, 5.2, 5.8, 5.8 years, a height of –2.9, –2.4, –2.8, –2.9 SDS and a GH dose of 27, 28, 41, 39 µg/kg/day, the children grew 0.9, 0.9, 0.8, 0.9 SDS in height, respectively. Insulin-like growth factor-1 (IGF-1) at GH start was, respectively, –2.1, –2.2, –0.4, –0.9 SDS and rose to (delta IGF-1) 1.8, 2.0, 1.7, 1.5 SDS during the first year on GH. All differences were not significant. Conclusions: We show for the first time that short stature children with low birth weight born AGA experience the same increase in height and IGFs to GH treatment as those born SGA irrespective of actual GH secretory status.

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 predict the frequency of type 1 diabetes in childhood and adolescence (

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.

To investigate the role of genetic and environmental factors in the pathogenesis of type 1 diabetes mellitus (T1D), we carried out a study in Germany aimed at comparing the prevalence and incidence of T1D among children of migrant Italians from high-risk (Sardinia) and low-risk (continental Italy) regions versus German children. Children from Italy were identified by the “Baden-Wuerttemberg (BW) Diabetes Incidence Registry”, which registered 4017 newly diagnosed T1D patients, aged 0–14 years, between 1987 and 2003. Data relating to T1D children from Sardinia were elicited from more than 2000 questionnaires. Our findings were: (1) T1D is more frequent among German children than among children of Italian migrants [incidence rate (IR) 14.8/100,000/year, 95% confidence interval (CI) 14.4–15.4 vs. IR 10.8/100,000/year, 95% CI 8.2–13.6); (2) the incidence of T1D among Italian children residing in Germany is similar to that of Italian children in the home country (IR 10.8/100,000/year, 95% CI 8.2–13.6 vs. 8.4/100,000/year, 95% CI 7.9–8.9); (3) the prevalence of T1D among Sardinian children is higher than that among German children (0.11%, 95% CI 0.11–0.12) independent of the place where the Sardinian children are living (Sardinian children in Germany 2.3%, 95% CI 0.5–6.5 vs. Sardinian children in Sardinia 0.30%, 95% CI 0.27–0.32). Conclusion: Children from high- and low-risk areas of Italy have incidence rates of T1D that are closer to those of their native regions than to those of German children, indicating that genetic factors play a predominant role in the pathogenesis of T1D.

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.