ESPE2023 Free Communications Diabetes and insulin 2 (6 abstracts)
Characterization of pediatric patients with type 2 diabetes and trends in their pharmaceutical management 2000-2022 in German-speaking countries: Analysis based on the DPV registry
Marianne Becker 1 , Susanna Wiegand 2 , Stefanie Schmid 3 , Daniel Weghuber 4 , Susann Weihrauch-Blüher 5 , Thomas Reinehr 6 , Thomas Kapellen 7,8 , Martin Tauschmann 9 , Christian Denzer 10 , Antje Körner 11,12 & Reinhard W Holl 3
1Department of Pediatric endocrinology and diabetology (DECCP), Centre hospitalier de Luxembourg, Luxembourg, Luxembourg. 2Department of Pediatric endocrinology and diabetology, Charité Universitätsmedizin Berlin, Berlin, Germany. 3Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany. 4Department of Pediatrics, Paracelsus Private Medical School, Salzburg, Austria. 5Department of Operative and Conservative Pediatric and Adolescent Medicine (DOKKJ), University Hospital Halle/S., Department of Pediatrics I/Ped. Endocrinology and Diabetology, Halle, Germany. 6Vestische Hospital for Children and Adolescents Datteln, Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, University of Witten/Herdecke, Datteln, Germany. 7Department of Pediatrics, MEDIAN Clinic for Children 'Am Nicolausholz' Bad Kösen, Naumburg, Germany. 8University of Leipzig, Leipzig, Germany. 9Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria. 10Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany. 11Center for Pediatric Research, University Hospital for Children and Adolescents, Medical Faculty, University of Leipzig, Leipzig, Germany. 12Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
Introduction: The prevalence of pediatric type 2 diabetes (T2D) increased over the last 2 decades, related to the rise in obesity. Meanwhile, treatment options for T2D have evolved considerably. Therefore, we analyzed changes in treatment approaches for pediatric T2D over two decades.
Material and Methods: Patients with T2D from 321 pediatric diabetes centers (Austria 24, Switzerland 2, Luxemburg 1, Germany 290) were recorded in the multicenter German Diabetes Prospective Follow-up Registry DPV, diagnosed younger than 18 years and with a medical follow-up between 2000 and 2022. Statistical analysis was performed using the Wilcoxon rank sum test for continuous and Chi-square test for qualitative variables with adjustment for multiple testing (Bonferroni step-down). For longitudinal observations, adjusted regression models were used.
Results: 2554 patients with T2D fulfilled the inclusion criteria, with mean age 15.9 years, HbA1c 7.8% and BMI-SDS 2.0 (German KiGGS data), 42% were male and 22% were non-Caucasian. At diagnosis, boys were older (14.36 vs 13.78 years, P<0.001) and more severely obese (2.04 vs 1.97 BMI-SDS, P= 0.014). During the first 12 weeks, male patients were more frequently started on insulin (16.6% vs 9.2%, P<0.001) but the rate of continuous insulin therapy tended to be lower (26.2% vs 28.2%, ns). When comparing different T2D age groups at diagnosis (A: 6-11 ys, n=456; B: 12-18 ys, n=2098), older patients were more often treated exclusively by oral antidiabetic drugs (OAD) and/or GLP-1 analogues (GLP1a) (49.8% vs 34.2%; P<0.001) whereas younger patients tended to be treated more frequently with a combination of insulin and OAD (23.5% vs 18.6%; P=0.12) or exclusively with insulin (11.2% vs 7.2%; P=0.03). Over the last 22 years, we observe a significant increase of BMI SDS (P<0.001) and age (P<0.001) at diagnosis. Regarding patient management, fewer patients were treated with lifestyle intervention alone (P<0.001) or insulin monotherapy (P<0.001), whereas treatment with a combination of insulin and OAD/GLP1a (P<0.001) and OAD/GLP1a monotherapy (P<0.001) increased. Currently Metformin is the most commonly used agent (64%) in pediatric T2D (increase in prescriptions since 2001), followed by insulin (27%) and GLP1a (6%, increase in prescriptions since 2018). Mean HbA1c levels under therapy remained stable (P=0.58).
Conclusions: While HbA1c levels in pediatric T2D remained stable throughout the past 22 years, patients became more severely obese and older at diagnosis. Pharmacological therapy has changed significantly from lifestyle intervention alone or insulin monotherapy to an increasing use of OAD/GLP1a (alone or in combination with insulin).
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