Bohn Barbara, Karges Beate, Vogel Christian, Otto Klaus-Peter, Marg Wolfgang, Hofer Sabine E, Fröhlich-Reiterer Elke, Holder Martin, Plamper Michaela, Wabitsch Martin, Kerner Wolfgang, Holl Reinhard W
Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.
German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
PLoS One. 2016 Aug 17;11(8):e0160971. doi: 10.1371/journal.pone.0160971. eCollection 2016.
To investigate changes in diabetes treatment over the last two decades in three age-groups of children and adolescents with type 1 diabetes (T1D) from Germany and Austria.
63,967 subjects (<18yr) with T1D documented between 1995 and 2014 from the DPV-database were included and stratified according to age (0.5-<6, 6-<12, 12-<18yr). Regression models were applied for insulin regimens (<3 and ≥4 injection time points/day, or continuous subcutaneous insulin infusion (CSII)), use of rapid- and long acting insulin analogues, NPH insulin, and frequency of self-monitoring of blood glucose (SMBG)/day. Models were adjusted for sex, diabetes duration, and migration background. P-value for trend was given.
The number of subjects with <3 injection time points/day decreased from 1995 to 2014 to <5% in all age-groups (p<0.0001). Proportion of patients with ≥4 injections/day increased until the early 2000s, and then declined until 2014. This trend was not found in 6-<12yr olds (p = 0.3403). CSII increased in all age-groups (p<0.0001) with the highest increase in children <6 years (from 0.4% to 79.2%), and the lowest increase in 12-<18 year olds (from 1.0% to 38.9%). NPH insulin decreased in all age-groups (p<0.0001). Insulin analogues, especially rapid-acting, became more frequent in all age-groups (p<0.0001), accounting for 78.4% in 2014 for all subjects. The highest use was found in the youngest children (in 2014: 85.6%), the lowest use in 6-<12 year olds (in 2014: 72.9%). The number of SMBG/day increased from 2.2 to 6.4 with a similar rise in all age-groups (p<0.0001). Frequency was highest in subjects <6yr.
In all age-groups, T1D treatment was intensified over the last 20 years. Age-specific differences in trends were particularly observed in the number of patients on CSII, in the number of patients with 4 or more injections/day, and in the frequency of SMBG/day.
调查过去二十年间德国和奥地利三个年龄组的1型糖尿病（T1D）儿童及青少年的糖尿病治疗变化情况。
纳入1995年至2014年间DPV数据库中记录的63967例18岁以下T1D患者，并按年龄（0.5 - <6岁、6 - <12岁、12 - <18岁）分层。应用回归模型分析胰岛素治疗方案（每日注射时间点<3次和≥4次，或持续皮下胰岛素输注（CSII））、速效和长效胰岛素类似物的使用情况、中效胰岛素（NPH胰岛素）以及每日自我血糖监测（SMBG）频率。模型对性别、糖尿病病程和移民背景进行了校正。给出了趋势的P值。
1995年至2014年间，所有年龄组中每日注射时间点<3次的患者数量均降至<5%（p<0.0001）。每日注射≥4次的患者比例在21世纪初之前有所增加，之后至2014年呈下降趋势。6 - <12岁年龄组未发现此趋势（p = 0.3403）。所有年龄组的CSII使用率均有所增加（p<0.0001），其中<6岁儿童增加最多（从0.4%增至79.2%），12 - <18岁年龄组增加最少（从1.0%增至38.9%）。所有年龄组的NPH胰岛素使用率均下降（p<0.0001）。胰岛素类似物，尤其是速效胰岛素类似物，在所有年龄组的使用频率均增加（p<0.0001），2014年所有受试者中占78.4%。最年轻儿童的使用率最高（2014年：85.6%），6 - <12岁年龄组最低（2014年：72.9%）。每日SMBG次数从2.2次增加至6.4次，所有年龄组增幅相似（p<0.0001）。<6岁受试者的频率最高。
在过去20年中，所有年龄组的T1D治疗均得到强化。在接受CSII治疗的患者数量、每日注射4次或更多次的患者数量以及每日SMBG频率方面，尤其观察到了年龄特异性趋势差异。
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