Background: Depending on age, needs and preferences in insulin therapy strongly differ between children and adolescents with type 1 diabetes (T1D).
Objective and hypotheses: To analyse trends in insulin regimen and type of insulin used over the last two decades in three age-groups of pediatric patients with T1D from Germany/Austria.
Method: 63 967 subjects (<18 year of age) with T1D documented between 1995 and 2014 from the Diabetes-Patienten-Verlaufsdokumentation (DPV) database were included. Patients were assigned to age-groups (0.5<6, 6<12, and 12<18 year). Regression models were built for insulin regimens (<3 and 4 or more injection time points/day, or continuous subcutaneous insulin infusion (CSII)), use of rapid- and long-acting insulin analogues, use of NPH insulin, and frequency of self-monitoring of blood glucose (SMBG)/day. Confounders: sex, diabetes duration, and migration background. P value for trend (SAS:9.4).
Results: The number of patients with <3 injection time points/day decreased from 1995 to 2014 to <5% in all age-groups (P<0.0001; respectively). Proportion of patients with four or more injections/day increased until the early 2000s, and decreased again until 2014. CSII increased in age-groups (P<0.0001, respectively), especially in patients <6 year to 79.2% (2014). The use of rapid-acting insulin analogues increased in all age-groups (P<0.0001, respectively) accounting for 78.4% (2014) for all subjects. The use of NPH insulin declined whereas the use of long-acting insulin analogues increased (all P<0.0001) and were most frequently used in the oldest age-group by 46%. Number of SMBG/day increased from 2.2 (1995) to 6.4 (2014) with a similar rise in all age-groups (all P<0.0001). Frequency of SMBG/day was highest in subjects <6 year.
Conclusion: In all age-groups, treatment in T1D was intensified over the last 20 years. Differences in age-groups were present in the number of patients on CSII, in the proportion with 4 or more injections/day, in the use of long-acting insulin analogues, and in the frequency of SMBG/day.
10 Sep 2016 - 12 Sep 2016