Schiel Ralf, Stachow Rainer, Hermann Thomas, Satzke Ina, Büttner Thomas, Koch Sibylle, Enderlein Katja, Bambauer Rolf, Steveling Antje, Bollow Esther, Holl Reinhard W
MEDIGREIF Inselklinik Heringsdorf GmbH, Ostseebad Heringsdorf, Germany.
Fachklinik Sylt, Westerland, Germany.
Exp Clin Endocrinol Diabetes. 2020 Feb;128(2):97-103. doi: 10.1055/a-0594-9311. Epub 2018 Jul 2.
In the treatment of children/adolescents with diabetes medical rehabilitation plays an important role. It was the aim of the survey to analyze trends in the number of patients admitted to rehabilitation, the quality of diabetes care, the incidence of acute complications, risk factors for cardiovascular co-morbidities like lipids and blood pressure and the familial status nationwide and over a period of 13 years.
Currently seven hospitals offer in-patient rehabilitation for children/adolescents with diabetes in Germany. Six hospitals participated in the survey. All children/adolescents (n=7.163) who participated in an in-patient rehabilitation 01/01/2004-31/12/2016 were included. Clinical/familial data were assessed: age, sex, family situation, type/duration of diabetes, insulin dosage, self-monitoring, acute complications, height, body weight, blood pressure and laboratory parameters. For collecting and storage of data the computer software DPV® (Diabetes-Patienten-Verlaufsdokumentation, University of Ulm, Germany) was used. Statistical analyses were performed using the programme SAS (Statistical Analysis Software 9.4, SAS Institute Inc, Cary, North Carolina, USA).
During the study period 7.163 patients took part in 10.987 in-patient rehabilitation procedures. The yearly number of patients participating in rehabilitation remained stable. There was no change in the quality of diabetes control (HbA1c: p=0.30, fasting blood glucose: p=0.80). The incidence of severe hypoglycaemia decreased (p<0.001). The incidence of ketacidosis remained stable (p=0.18). The frequency of blood glucose self-monitoring increased (p<0.001). The same was true for patients treated with CSII (p<0.001), whereas the numbers of patients treated with CT or ICT decreased (both p<0.001). There was no change in patients' total insulin dose (p=0.01). There was a decrease of the number of patients living with both parents (p<0.001), the percentage of children/adolescents living with mother or father alone increased (p<0.001). The percentage of children/adolescents living in mixed cultural families or having a background of immigration increased (p<0.001).
There is a change in medical rehabilitation: The number is stable, the proportion of patients using CSII increased, the number of patients living with single parents and the percentage of patients from culturally mixed families increased also.
在儿童/青少年糖尿病的治疗中，医学康复起着重要作用。本次调查旨在分析全国范围内13年间糖尿病康复住院患者数量的趋势、糖尿病护理质量、急性并发症的发生率、血脂和血压等心血管合并症的危险因素以及家庭状况。
目前德国有7家医院为儿童/青少年糖尿病患者提供住院康复治疗。6家医院参与了此次调查。纳入了2004年1月1日至2016年12月31日期间所有参与住院康复治疗的儿童/青少年（n = 7163）。评估了临床/家庭数据：年龄、性别、家庭状况、糖尿病类型/病程、胰岛素剂量、自我监测、急性并发症、身高、体重、血压和实验室参数。使用计算机软件DPV®（糖尿病患者病程记录，德国乌尔姆大学）收集和存储数据。使用SAS程序（统计分析软件9.4，美国北卡罗来纳州卡里市SAS研究所）进行统计分析。
在研究期间，7163名患者参与了10987次住院康复治疗。每年参与康复治疗的患者数量保持稳定。糖尿病控制质量没有变化（糖化血红蛋白：p = 0.30，空腹血糖：p = 0.80）。严重低血糖的发生率下降（p < 0.001）。酮症酸中毒的发生率保持稳定（p = 0.18）。血糖自我监测的频率增加（p < 0.001）。持续皮下胰岛素输注（CSII）治疗的患者情况相同（p < 0.001），而接受常规胰岛素（CT）或胰岛素笔式注射器（ICT）治疗的患者数量减少（均为p < 0.001）。患者的总胰岛素剂量没有变化（p = 0.01）。与父母双方共同生活的患者数量减少（p < 0.001），与母亲或父亲单独生活的儿童/青少年比例增加（p < 0.001）。生活在文化混合家庭或有移民背景的儿童/青少年比例增加（p < 0.001）。
医学康复出现了变化：数量稳定，使用CSII的患者比例增加，单亲家庭生活的患者数量以及文化混合家庭患者的比例也增加了。
