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Lanzinger S, Biester T, Siegel E, Schneider A, Schöttler H, Placzek K, Klinkert C, Heidtmann B, Ziegler J, Holl RW. The impact of daily mean air temperature on the proportion of time in hypoglycemia in 2,582 children and adolescents with type 1 diabetes - Is this association clinically relevant? Environ Res 2023; 233:116488. [PMID: 37356532 DOI: 10.1016/j.envres.2023.116488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/01/2023] [Accepted: 06/21/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES To study the potential association between increases in daily mean air temperature and time below range (TBR <54 mg/dl) and time above range (TAR >250 mg/dl) in children and adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS Individuals with type 1 diabetes <21 years with information on daily glucose profiles from the diabetes prospective follow-up study (DPV) were included (n = 2582). Further inclusion criteria were age at least 6 months at diabetes onset, diabetes duration for at least one year and treatment years 2020-2021. Mean daily air temperature and other meteorological parameters from 78 measurement stations in Germany were linked to the individual glucose sensor profile via the five-digit postcode areas of residency. We used multivariable repeated measures fractional logistic regression models with a compound symmetry covariance structure to study the association between a 1 °C increase in daily mean temperature and time in specific glucose ranges. RESULTS A 1 °C increase in daily mean temperature was associated with an acute (Odds Ratio (OR) 1.009 (95%-CI 1.007, 1.011)) and up to 7 days delayed (OR 1.003 (1.001, 1.005)) increase in TBR <54 mg/dl. Moreover, an acute decrease in TAR >250 mg/dl (OR 0.997 (0.996, 0.997)) was found. CONCLUSIONS Results of the DPV registry showed small, but statistically significant changes in TBR and TAR in association with a short-term temperature increase. Higher blood flow and faster insulin absorption might be one possible mechanism. In times of increasing temperature fluctuations meteorological impacts on time in range could become even more relevant.
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Affiliation(s)
- S Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - T Biester
- AUF DER BULT, Diabetes-Center for Children and Adolescents, Hannover, Germany
| | - E Siegel
- Department of Internal Medicine, St. Josefs Hospital GmbH, Heidelberg, Germany
| | - A Schneider
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - H Schöttler
- Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt, Germany
| | - K Placzek
- Department of Pediatrics, Medical Faculty, Martin-Luther University Halle-Wittenberg, Halle, Saale, Germany
| | - C Klinkert
- Diabetes Specialized Practice for Children and Adolescents, Herford, Germany
| | - B Heidtmann
- Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | - J Ziegler
- University Children's Hospital Tübingen, Tübingen, Germany
| | - R W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Biester T, Hermann J, Heidtmann B, Rami-Merhar B, Ermer U, Wolf J, Freff M, Karges B, Agena D, Danne T, Holl R. Intermittierend gescannte Glukoseprofile (FGM) bei Kindern und Jugendlichen mit Typ-1-Diabetes: Korrelation mit traditioneller Bewertung der Stoffwechseleinstellung (HbA1c-Wert) – eine multizentrische DPV-Analyse. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- T Biester
- Kinder- und Jugendkrankenhaus 'Auf der Bult', Hannover, Germany
| | - J Hermann
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
| | - B Heidtmann
- Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Germany
| | - B Rami-Merhar
- Medizinische Universität Wien, Universitätsklinik für Kinder- und Jugendheilkunde, Wien, Austria
| | - U Ermer
- Kliniken St. Elisabeth, Klinik für Kinder- und Jugendmedizin, Neuburg, Germany
| | - J Wolf
- St. Louise-Krankenhaus, Klinik für Kinder- und Jugendmedizin, Paderborn, Germany
| | - M Freff
- Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt, Germany
| | - B Karges
- Bethlehem Gesundheitszentrum, Klinik für Kinder- und Jugenmedizin, Stolberg, Germany
| | - D Agena
- Kinderärztliche Gemeinschaftspraxis Dr. med. Heinz-A. Mogalle und Dirk Agena, Hildesheim, Germany
| | - T Danne
- Kinder- und Jugendkrankenhaus 'Auf der Bult', Hannover, Germany
| | - R Holl
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
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Neu A, Beyer P, Bürger-Büsing J, Danne T, Etspüler J, Heidtmann B, Holl R, Karges B, Kiess W, Knerr I, Kordonouri O, Lange K, Lepler R, Marg W, Näke A, Petersen M, Podeswik A, Stachow R, von Sengbusch S, Wagner V, Ziegler R, Holterhus P. Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1553882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- A. Neu
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen
| | - P. Beyer
- Klinik für Kinder und Jugendliche, Evangelisches Krankenhaus GmbH, Oberhausen
| | | | - T. Danne
- Diabetes-Zentrum für Kinder und Jugendliche, Kinderkrankenhaus auf der Bult, Hannover
| | | | - B. Heidtmann
- Kindermedizinisches Versorgungszentrum am Wilhelmstift, Hamburg
| | - R. Holl
- Abt. Epidemiologie, Universitätsklinikum Ulm
| | | | - W. Kiess
- Universitätsklinik und Poliklinik für Kinder und Jugendliche, Leipzig
| | - I. Knerr
- Kinder- und Jugendklinik des Universitätsklinikums Erlangen
| | - O. Kordonouri
- Diabetes-Zentrum für Kinder und Jugendliche, Kinderkrankenhaus auf der Bult, Hannover
| | - K. Lange
- Medizinische Hochschule, Medizinische Psychologie, Hannover
| | - R. Lepler
- Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg
| | - W. Marg
- Klinikum Bremen-Mitte gGmbH, Zentrum für Kinderheilkunde und Jugendmedizin, Bremen
| | - A. Näke
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden
| | - M. Petersen
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | | | - R. Stachow
- Fachklinik Sylt für Kinder und Jugendliche, Westerland
| | - S. von Sengbusch
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - V. Wagner
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - R. Ziegler
- Diabetologische Schwerpunktpraxis, Münster
| | - P. Holterhus
- Klinik für allgemeine Pädiatrie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
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Danne T, Bollow E, Schwandt A, Heidtmann B, Kordonouri O, Rami-Merhar B, Ziegler R, Holl RW. Charakteristika der 1279 Patchpumpen-Nutzer im deutsch-östereichischen DPV-Register*. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Böttcher C, Utsch B, Borkenstein M, v Schnurbein J, Eckstein E, Holder M, Heidtmann B, Bollow E, Holl RW. Glomeruläre Filtrationsraten als Marker der Nierenfunktion bei Kindern und Jugendlichen mit Typ I Diabetes. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Neu A, Beyer P, Bürger-Büsing J, Danne T, Etspüler J, Heidtmann B, Holl R, Karges B, Kiess W, Knerr I, Kordonouri O, Lange K, Lepler R, Marg W, Näke A, Petersen M, Podeswik A, Stachow R, von Sengbusch S, Wagner V, Ziegler R, Holterhus P. Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0034-1385412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A. Neu
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen
| | - P. Beyer
- Klinik für Kinder und Jugendliche, Evangelisches Krankenhaus GmbH, Oberhausen
| | | | - T. Danne
- Diabetes-Zentrum für Kinder und Jugendliche, Kinderkrankenhaus auf der Bult, Hannover
| | | | - B. Heidtmann
- Kindermedizinisches Versorgungszentrum am Wilhelmstift, Hamburg
| | - R. Holl
- Abt. Epidemiologie, Universitätsklinikum Ulm
| | | | - W. Kiess
- Universitätsklinik und Poliklinik für Kinder und Jugendliche, Leipzig
| | - I. Knerr
- Kinder- und Jugendklinik des Universitätsklinikums Erlangen
| | - O. Kordonouri
- Diabetes-Zentrum für Kinder und Jugendliche, Kinderkrankenhaus auf der Bult, Hannover
| | - K. Lange
- Medizinische Hochschule, Medizinische Psychologie, Hannover
| | - R. Lepler
- Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg
| | - W. Marg
- Klinikum Bremen-Mitte gGmbH, Zentrum für Kinderheilkunde und Jugendmedizin, Bremen
| | - A. Näke
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden
| | - M. Petersen
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | | | - R. Stachow
- Fachklinik Sylt für Kinder und Jugendliche, Westerland
| | - S. von Sengbusch
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - V. Wagner
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - R. Ziegler
- Diabetologische Schwerpunktpraxis, Münster
| | - P. Holterhus
- Klinik für allgemeine Pädiatrie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
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Neu A, Beyer P, Bürger-Büsing J, Danne T, Etspüler J, Heidtmann B, Holl R, Karges B, Kiess W, Knerr I, Kordonouri O, Lange K, Lepler R, Marg W, Näke A, Petersen M, Podeswik A, Stachow R, von Sengbusch S, Wagner V, Ziegler R, Holterhus P. Diagnosis, Therapy and Control of Diabetes Mellitus in Children and Adolescents. Exp Clin Endocrinol Diabetes 2014; 122:425-34. [DOI: 10.1055/s-0034-1366384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- A. Neu
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen
| | - P. Beyer
- Klinik für Kinder und Jugendliche, Evangelisches Krankenhaus GmbH, Oberhausen
| | | | - T. Danne
- Diabetes-Zentrum für Kinder und Jugendliche, Kinderkrankenhaus auf der Bult, Hannover
| | | | - B. Heidtmann
- Kindermedizinisches Versorgungszentrum am Wilhelmstift, Hamburg
| | - R. Holl
- Abt. Epidemiologie, Universitätsklinikum Ulm
| | - B. Karges
- Sektion Endokrinologie und Diabetologie, RWTH Aachen
| | - W. Kiess
- Universitätsklinik und Poliklinik für Kinder und Jugendliche, Leipzig
| | - I. Knerr
- Kinder- und Jugendklinik des Universitätsklinikums Erlangen
| | - O. Kordonouri
- Diabetes-Zentrum für Kinder und Jugendliche, Kinderkrankenhaus auf der Bult, Hannover
| | - K. Lange
- Medizinische Hochschule, Medizinische Psychologie, Hannover
| | - R. Lepler
- Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg
| | - W. Marg
- Klinikum Bremen-Mitte gGmbH, Zentrum für Kinderheilkunde und Jugendmedizin, Bremen
| | - A. Näke
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden
| | - M. Petersen
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - A. Podeswik
- Bundesverband Bunter Kreis e. V., Institut für Sozialmedizin in der Pädiatrie, Augsburg
| | - R. Stachow
- Fachklinik Sylt für Kinder und Jugendliche, Westerland
| | - S. von Sengbusch
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - V. Wagner
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - R. Ziegler
- Diabetologische Schwerpunktpraxis, Münster
| | - P. Holterhus
- Klinik für allgemeine Pädiatrie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
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Neu A, Beyer P, Bürger-Büsing J, Danne T, Etspüler J, Heidtmann B, Holl R, Karges B, Kiess W, Knerr I, Kordonouri O, Lange K, Lepler R, Marg W, Näke A, Petersen M, Podeswik A, Stachow R, von Sengbusch S, Wagner V, Ziegler R, Holterhus P. Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1350564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A. Neu
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen
| | - P. Beyer
- Klinik für Kinder und Jugendliche, Evangelisches Krankenhaus GmbH, Oberhausen
| | | | - T. Danne
- Diabetes-Zentrum für Kinder und Jugendliche, Kinderkrankenhaus auf der Bult, Hannover
| | | | - B. Heidtmann
- Kindermedizinisches Versorgungszentrum am Wilhelmstift, Hamburg
| | - R. Holl
- Abt. Epidemiologie, Universitätsklinikum Ulm
| | | | - W. Kiess
- Universitätsklinik und Poliklinik für Kinder und Jugendliche, Leipzig
| | - I. Knerr
- Kinder- und Jugendklinik des Universitätsklinikums Erlangen
| | - O. Kordonouri
- Diabetes-Zentrum für Kinder und Jugendliche, Kinderkrankenhaus auf der Bult, Hannover
| | - K. Lange
- Medizinische Hochschule, Medizinische Psychologie, Hannover
| | - R. Lepler
- Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg
| | - W. Marg
- Klinikum Bremen-Mitte gGmbH, Zentrum für Kinderheilkunde und Jugendmedizin, Bremen
| | - A. Näke
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden
| | - M. Petersen
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | | | - R. Stachow
- Fachklinik Sylt für Kinder und Jugendliche, Westerland
| | - S. von Sengbusch
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - V. Wagner
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - R. Ziegler
- Diabetologische Schwerpunktpraxis, Münster
| | - P. Holterhus
- Klinik für allgemeine Pädiatrie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
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Kapellen T, Heidtmann B, Lilienthal E, Engler-Schmidt C, Bartelt H, Holl R. Insulinpumpentherapie bei Neugeborenen und Säuglingen. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Neu A, Beyer P, Bürger-Büsing J, Danne T, Etspüler J, Heidtmann B, Holl R, Karges B, Kiess W, Knerr I, Kordonouri O, Lange K, Lepler R, Marg W, Näke A, Petersen M, Podeswik A, Stachow R, von Sengbusch S, Wagner V, Ziegler R, Holterhus P. Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1325581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Icks A, Razum O, Rosenbauer J, Bächle C, Hungele A, Mönkemöller K, Müller-Godeffroy E, Heidtmann B, Kapellen T, Moltz K, Holl RW. Pumpentherapie wird bei türkischstämmigen Kindern und Jugendlichen mit Typ 1-Diabetes deutlich seltener eingesetzt als bei Typ 1-diabetischen Kindern und Jugendlichen ohne Migrationshintergrund. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Neu A, Beyer P, Bürger-Büsing J, Danne T, Etspüler J, Heidtmann B, Holl R, Karges B, Kiess W, Knerr I, Kordonouri O, Lange K, Lepler R, Marg W, Näke A, Petersen M, Podeswik A, Stachow R, von Sengbusch S, Wagner V, Ziegler R, Holterhus P. Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1283769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Liebner T, Gialeli G, Heidtmann B, Holl RW, Lilienthal E, Molz K, Hungele A. Insulinpumpenkatheter-Komplikationen im Kindes- und Jugendalter. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Neu A, Beyer P, Bürger-Büsing J, Danne T, Etspüler J, Heidtmann B, Holl R, Karges B, Kiess W, Knerr I, Kordonouri O, Lange K, Lepler R, Marg W, Näke A, Petersen M, Podeswik A, Stachow R, von Sengbusch S, Wagner V, Ziegler R, Holterhus P. Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1262636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Liebner T, Holl R, Heidtmann B, Lilienthal E, Molz K, Hungele A, Bergheim F, Gialeli G. Insulinpumpenkatheter – Komplikationen im Kindes- und Jugendalter. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hofer SE, Heidtmann B, Raile K, Fröhlich-Reiterer E, Lilienthal E, Berghaeuser MA, Holl RW. Discontinuation of insulin pump treatment in children, adolescents, and young adults. A multicenter analysis based on the DPV database in Germany and Austria. Pediatr Diabetes 2010; 11:116-21. [PMID: 19566740 DOI: 10.1111/j.1399-5448.2009.00546.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Insulin pump therapy is well established in the treatment of children and adolescents with type 1 diabetes. Most studies focus on outcome parameters like hemoglobin A1c (HbA1c), hypoglycemia, and quality of life, whereas few reports address patients who discontinue pump therapy. OBJECTIVE This survey focuses on the discontinuation rate of insulin pump treatment in the pediatric and young adult age group. SUBJECTS AND METHODS The prospective multicenter Diabetes Patienten Verlausdokumentation (DPV) (electronic diabetes patient documentation system) database has been established since 1990 and is broadly used in Germany and Austria. All pump users among the participating centers documented since 1995 were included in this analysis. RESULTS In total, 11 710 patients with type 1 diabetes were recorded as treated with insulin pumps. In total, 463 patients (4%) switched from insulin pump treatment to multiple daily injections (MDI). In the group of patients who stopped with pump treatment, the mean duration of pump therapy was 1.7 yr (SE +/- 0.06 yr), 60.5% of patients were female. Subdivided into age groups, the discontinuation rate was lowest in the age group < 5 yr (0.1%), followed by the groups aged 5-10 yr (0.3%) and 15-20 yr (0.8%). The group aged 10-15 yr showed the highest rate of discontinuation (2%). CONCLUSIONS The discontinuation rate of insulin pump therapy is, in general, low (4%). The younger the patients at the time of initiating insulin pump treatment, the lower is the discontinuation rate. The highest rate was seen in adolescents aged 10-15 yr. Girls stopped insulin pump treatment more often than boys (60.5% vs. 39.5%).
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Affiliation(s)
- S E Hofer
- Department of Pediatrics, Medical University of Innsbruck, 6020 Innsbruck, Austria.
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Neu A, Beyer P, Bürger-Büsing J, Danne T, Etspüler J, Heidtmann B, Holl R, Karges B, Kiess W, Knerr I, Kordonouri O, Lange K, Lepler R, Marg W, Näke A, Petersen M, Podeswik A, Stachow R, Sengbusch SV, Wagner V, Ziegler R, Holterhus P. Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1224581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hofer SE, Heidtmann B, Raile K, Fröhlich-Reiterer E, Lilienthal E, Berghäuser M, Holl RW. Erhebung der Insulinpumpenrückgaberate bei Kindern und Jugendlichen mit Diabetes mellitus Typ 1 anhand der DPV Datenbank. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Berghaeuser MA, Kapellen T, Heidtmann B, Haberland H, Klinkert C, Holl RW. Continuous subcutaneous insulin infusion in toddlers starting at diagnosis of type 1 diabetes mellitus. A multicenter analysis of 104 patients from 63 centres in Germany and Austria. Pediatr Diabetes 2008; 9:590-5. [PMID: 18503495 DOI: 10.1111/j.1399-5448.2008.00416.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- M A Berghaeuser
- Department of Paediatrics, University of Muenster, Muenster, Germany.
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Danne T, Beyer P, Etspüler J, Heidtmann B, Holl R, Holterhus P, Kiess W, Knerr I, Kordonouri O, Lange K, Lepler R, Marg W, Näke A, Neu A, Petersen M, Ziegler R. Diabetes mellitus im Kindes- und Jugendalter. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1004683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jakisch BI, Wagner VM, Heidtmann B, Lepler R, Holterhus PM, Kapellen TM, Vogel C, Rosenbauer J, Holl RW. Comparison of continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) in paediatric Type 1 diabetes: a multicentre matched-pair cohort analysis over 3 years. Diabet Med 2008; 25:80-5. [PMID: 18199134 DOI: 10.1111/j.1464-5491.2007.02311.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS To conduct a multicentre, matched-pair cohort analysis comparing glycaemic control and adverse events of continuous subcutaneous insulin infusion (CSII) with multiple daily injections (MDI) in paediatric patients. METHODS Using standardized computer-based prospective documentation, HbA(1c), insulin dose, body mass index-standard deviation score (BMI-SDS), rate of hypoglycaemia, rate of diabetic ketoacidosis (DKA) and intensity of care were analysed in 434 matched pairs during a follow-up period of 3 years after initiation of MDI or CSII. RESULTS HbA(1c) was significantly lower in the CSII group during the first year of new regimen (CSII 7.5 +/- 0.05 vs. MDI 7.7 +/- 0.06; P < 0.05), but rose to the same level as in the MDI group during year 3. Insulin requirement remained significantly lower in the CSII group. The BMI-SDS increased in both study groups, with no significant difference. The rate of severe hypoglycaemia decreased significantly after the change of regimen (CSII 17.87 +/- 2.85 vs. MDI 25.14 +/- 3.79; P < 0.05) and during year 3 of the regimen, particularly when compared with baseline (-21% vs. -16%). The rate of DKA was lower at baseline in the CSII group and remained significantly lower over all 3 years. Intensity of care was the same in both subsets. CONCLUSIONS Employing a large cohort, this matched-pair analysis has demonstrated over a 3-year study period that CSII is a safe form of intensive insulin therapy with similar glycaemic effects, but with significantly reduced rates of hypoglycaemia and DKA and a lower insulin requirement when compared with MDI.
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Affiliation(s)
- B I Jakisch
- Catholic Children's Hospital Wilhelmstift, Hamburg, Germany.
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Bielstein A, Böhle A, Sonnenberg B, Siefert S, Heidtmann B, Lepler R. Drei Jahre sozialmedizinische Nachsorge des Diabetes-Teams der Familienorientierten Nachsorge Hamburg SeeYou für Kinder und Jugendliche mit Typ-1-Diabetes – eine erste Datensammlung zum Umfang der Nachsorge. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Klinkert C, Bachran R, Heidtmann B, Grabert M, Holl RW. Age-specific characteristics of the basal insulin-rate for pediatric patients on CSII. Exp Clin Endocrinol Diabetes 2007; 116:118-22. [PMID: 17973210 DOI: 10.1055/s-2007-990296] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study intends to analyse the basal insulin dosage for pediatric patients (0-18 years) with type 1 diabetes on insulin-pump therapy (CSII). RESEARCH DESIGN AND METHODS In a large German and Austrian prospectively documented data base (DPV) for children with diabetes, patients with CSII were identified. The documented basal rates from patients (0-18 years) were analysed and related to age, gender, duration of diabetes, body weight and type of insulin used in the pump. Data were evaluated for three age groups (0-6; >6-12; >12-18 years). RESULTS Complete data sets with documented hourly intervals of basal rate were available from 743 patients. Basal insulin dosage in the 3 age groups differed significantly (0-6 years 0.20 IU/kg body weight; >6-12 years 0.34 IU/kg body weight; >12-18 years 0.41 IU/kg body weight p<0.0001). The amount of basal insulin in 24 hours in each group correlates with body weight, age and duration of diabetes. The circadian distribution of the basal rate shows different profiles in each age group. CONCLUSION Pediatric patients on CSII have age specific characteristics in total amount and circadian distribution of basal rates.
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Kapellen TM, Heidtmann B, Bachmann J, Ziegler R, Grabert M, Holl RW. Indications for insulin pump therapy in different age groups: an analysis of 1,567 children and adolescents. Diabet Med 2007; 24:836-42. [PMID: 17650157 DOI: 10.1111/j.1464-5491.2007.02224.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS The German working group for pump therapy in paediatric patients has defined seven indications for continuous subcutaneous insulin infusion (CSII): dawn phenomenon, reduction of severe hypoglycaemia, improvement of hyperglycaemia, more flexibility, motivation, failure of injection therapy and pregnancy. In this study we analysed age-specific differences for starting CSII in four age groups (group A: 0-4 years; group B: 5-9 years; group C: 10-14 years; group D: 15-19 years). We also investigated whether glycaemic goals could be reached. METHODS A total of 1567 children and adolescents (mean age 12.4 years, mean diabetes duration 5.2 years) with documented indications for CSII from the DPV-database (December 2005) were included. RESULTS Dawn phenomenon (27.4%), reduction of hypoglycaemia (20%) and improvement of hyperglycaemia (18.1%) were the commonest indications for starting CSII. Indications differed by age group (P < 0.0001). In infants and toddlers (group A, n = 138) reduction of hypoglycaemia (42.5%) was the commonest indication. For adolescents (group C, n = 789/group D, n = 408) dawn phenomenon (32.1/21.7%) and flexibility (21.7/25.8%) were the main indications. The rate of severe hypoglycaemia with coma in patients commencing CSII in order to reduce hypoglycaemia fell (12.1/100 patient years before CSII vs. 5.8 after 1 year, 4.49 at study end). Glycated haemoglobin (HbA(1c)) in patients with the treatment goal 'improvement of hyperglycaemia' was lowered significantly in the first year of CSII (HbA(1c) start: 8.8%; after 1 year: 8.5%, P < 0.01) and was stable thereafter (8.8% after 36 months). CONCLUSIONS CSII in children and adolescents is safe and can reduce the rate of severe hypoglycaemia without deterioration in glycaemic control. In patients with poor glucose control, a significant reduction in HbA(1c) can be achieved in the first year.
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Affiliation(s)
- T M Kapellen
- Hospital for Children and Adolescents, University of Leipzig, Germany.
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Holder M, Ludwig-Seibold C, Lilienthal E, Ziegler R, Heidtmann B, Holl R. Trends in der Insulinpumpentherapie bei Kindern, Jugendlichen und jungen Erwachsenen mit Typ-1-Diabetes von 1995-2006: Daten der DPV-Initiative. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-960666] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Danne T, Beyer P, Etspüler J, Heidtmann B, Holl R, Holterhus P, Kiess W, Knerr I, Kordonouri O, Lange K, Lepler R, Marg W, Näke A, Neu A, Petersen M, Ziegler R. Diabetes mellitus im Kindes- und Jugendalter. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-960641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Holder M, Ludwig-Seibold C, Lilienthal E, Ziegler R, Heidtmann B, Holl RW. Trends in der Insulinpumpentherapie bei Kindern, Jugendlichen und jungen Erwachsenen mit Typ-1-Diabetes von 1995–2006: Daten der DPV-Initiative. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Heidtmann B, Hilgard D, Kapellen T, Schumacher A, Lepler R, Schober E, Holl R. Die Insulinpumpentherapie bei kleinen Kindern bis zum 6. Lebensjahr: Vergleich der Stoffwechselparameter vor und 6 bzw. 12 Monate nach CSII-Beginn. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-960522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ziegler R, Heidtmann B, Hilgard D, Rosenbauer J, Holl RW. Häufigere Blutzuckermessungen bei Kindern und Jugendlichen mit Typ 1-Diabetes gehen mit besserer Stoffwechseleinstellung einher. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Heidtmann B, Deiss D, Gens E, Fröhlich-Reiterer E, Grabert M, Holl RW. Beendigung der Insulinpumpentherapie bzw. Wechsel von CSII auf ICT bei Diabetes mellitus Typ 1 im Kindes- und Jugendalter. Welche Charakteristika weisen diese Patienten auf? Auswertung der DPV-Wiss-Daten für die Insulinpumpen-AG und die DPV-Wiss-Initiative. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Danne T, Beyer P, Etspüler J, Heidtmann B, Holl R, Holterhus P, Kiess W, Knerr I, Kordonouri O, Lange K, Lepler R, Marg W, Näke A, Neu A, Petersen M, Ziegler R. Diabetes mellitus im Kindes- und Jugendalter. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-941469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kapellen T, Heidtmann B, Bachmann J, Ziegler R, Holl R. Die Insulinpumpe im Kindes- und Jugendalter: Unterschiede in den einzelnen Altersgruppen hinsichtlich der Therapieziele und deren Verwirklichung. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-943800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Heidtmann B, Hilgard D, Kapellen T, Schumacher A, Holl RW. Die Insulinpumpentherapie bei kleinen Kindern bis zum 6. Lebensjahr: Vergleich der Stoffwechselparameter vor und 12 Monate nach CSII-Beginn. Auswertung der DPV-Wiss-Daten für die Insulinpumpen-AG und die DPV-Wiss-Initiative. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-943799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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