ESPE2021 ePoster Category 2 Diabetes and insulin (72 abstracts)
Sex differences over two decades for glycaemic control, pump use and insulin dose in patients aged 10-20 years with type 1 diabetes
Claudia Boettcher 1 , Sascha R. Tittel 2,3 , Thomas Meissner 4 , Bettina Gohlke 5 , Rainer Stachow 6 , Axel Dost 7 & Stefanie Lanzinger 2,3
1Paediatric Endocrinology and Diabetology, University Children’s Hospital, University of Berne, Berne, Switzerland; 2Institute of Epidemiology and Medical Biometry (ZIBMT), Ulm University, Ulm, Germany; 3German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany; 4Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Children’s Hospital, Medical Faculty, Duesseldorf, Germany; 5Paediatric Endocrinology and Diabetology, Children’s Hospital, University of Bonn, Bonn, Germany; 6Sylt Specialist Clinic for Children and Adolescents, Westerland, Germany; 7Department of Paediatrics, University Hospital Jena, Jena, Germany
Background: Therapy in type 1 diabetes has undergone a fundamental change over the last several decades, especially by the use of technical devices. Another change that took place is the growing awareness of sex differences of all kind, e.g. as influencing factors of metabolic control. Our study aimed to evaluate sex differences over two decades with regard to changes in glycaemic control, with regard to trends in insulin pump use and insulin dose. Migration background was taken into account.
Methods: Via DPV database, type-1-diabetes patients aged 10-20 for the time period1999-2018 were identified. Linear regression analyses adjusted for age, duration of diabetes, migration background and repeated measurements were used to create HbA1c-trends, trends about insulin pump use and insulin dose. Subsequently, stratification by migration background was made.
Results: For the cohort’s characteristics see table. Both, girls and boys showed an HbA1c-decrease over the period examined: from 8.30 (8.24 – 8.35) to 8.07 (8.04-8.10)% in girls and from 8.15 (8.10-8.21) to 8.00 (7.98-8.04)% in boys. After stratification for migrant background a clear HbA1c-convergence between boys and girls was seen in those without migrant background as of 2016, but not in adolescents with migrant background. Use of insulin pumps increased continuously from 3% in 1999 (boys and girls) to 47% (boys) and 54% (girls), respectively in 2018. Adolescents with migration background used insulin pumps less frequently, with the girls being in the majority (2018: 48% girls, 40% boys). The daily insulin dose increased continuously from 1999-2018. An insulin dose levelling between boys and girls was seen.
| Parameter | N | |
| 1st year of analysis | 2009 (2004-2014) | 68,662 |
| Age (years) | 12.0 (10.4-14.6) | 68,662 |
| Female/male sex (%) | 46.8/53.2 | 68,662 |
| Migration background (%) | 17.0 | 68,662 |
| Diabetes duration (years) | 1.9 (0.2-5.6) | 68,662 |
| Insulin pump use (%) | 19.5 | 65,498 |
| HbA1c (%) | 7.73 (6.87-9.02) | 67,095 |
| Insulin dose (U/Kg/d) | 0.75 (0.57-0.95) | 64,534 |
Conclusion: The gap in metabolic control between boys and girls with type 1 diabetes seems to close, but in adolescents without migrant background only. HbA1c improvements are accompanied by increased insulin pump use, especially in girls. Sex differences in people with type 1 and migrant background needs to be addressed.
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