Improved Metabolic Control in Children and Adolescents With Type 1 Diabetes

OBJECTIVE To investigate the temporal trend of metabolic control and potential predictors in German and Austrian children and adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS This study is based on a large, multicenter database for prospective longitudinal documentation of diabetes care in Germany and Austria. Data from 30,708 patients documented in 305 diabetes centers between 1995 and 2009 were analyzed. Generalized linear mixed regression models were used to adjust trend analysis for relevant confounders. RESULTS Unadjusted mean HbA1c decreased from 8.7 ± 1.8% in 1995 to 8.1 ± 1.5% in 2009. In multiple regression analysis, treatment year, age, sex, diabetes duration, migration background, BMI-SDS, and daily insulin dose were significant predictors of metabolic control (P < 0.001). After multiple adjustment, mean HbA1c decreased significantly by 0.038% per year (95% CI 0.032–0.043%), average odds ratio (OR) per year for HbA1c >7.5% (>9.0%) was 0.969 (95% CI 0.961–0.977) (0.948, 95% CI 0.941–0.956). Intensified insulin regimen was associated with lower frequency of poor metabolic control (HbA1c >9%; P = 0.005) but not with average HbA1c (P = 0.797). Rate of severe hypoglycemia and hypoglycemic coma decreased significantly (relative risk [RR] per year 0.948, 95% CI 0.918–0.979; RR 0.917, 95% CI 0.885–0.950) over the study period. Diabetic ketoacidosis rate showed no significant variation over time. CONCLUSIONS This study showed a significant improvement in metabolic control in children and adolescents with type 1 diabetes during the past decade and a simultaneous decrease in hypoglycemic events. The improvement was not completely explained by changes in the mode of insulin treatment. Other factors such as improved patient education may have accounted for the observed trend.

• Publication year

  2011

• Venue

  Diabetes Care

• Publication date

  2011-12-09

• Fields of study

  Medicine

• Identifiers
  DOI 10.2337/dc11-0993PMID 22074726PMCID 3241332
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Frequency of SMBG correlates with HbA1c and acute complications in children and adolescents with type 1 diabetes

  2011cited by this paper
• Effect of Prior Intensive Therapy in Type 1 Diabetes on 10-Year Progression of Retinopathy in the DCCT/EDIC: Comparison of Adults and Adolescents

  2010cited by this paper
• The establishment of a new national network leads to quality improvement in childhood diabetes: Implementation of the ISPAD Guidelines

  2010cited by this paper
• Assessment and management of hypoglycemia in children and adolescents with diabetes

  2009cited by this paper
• Glycemic control in youth with diabetes: the SEARCH for diabetes in Youth Study.

  2009cited by this paper
• Improved metabolic outcome in a Danish diabetic paediatric population aged 0–18 yr: results from a nationwide continuous Registration

  2009cited by this paper
• Metabolic control as reflected by HbA1c in children, adolescents and young adults with type-1 diabetes mellitus: combined longitudinal analysis including 27,035 patients from 207 centers in Germany and Austria during the last decade.

  2008influential reference
• A1C in Children and Adolescents With Diabetes in Relation to Certain Clinical Parameters

  2008cited by this paper
• Severe hypoglycemia, metabolic control, and diabetes management in young children with type 1 diabetes using insulin analogs—a follow-up report of a large multicenter database

  2008cited by this paper
• Metabolic control as reflectet by HbA1c in children, adolescents and young adults with type-1 diabetes mellitus: combined longitudinal analysis including 27,035 patients from 207 centers in Germany and Austria during the last decade

  2008cited by this paper
• Assessment and management of hypoglycemia in children and adolescents with diabetes

  2008cited by this paper
• Continuing Stability of Center Differences in Pediatric Diabetes Care: Do Advances in Diabetes Treatment Improve Outcome? The Hvidoere Study Group on Childhood Diabetes

  2008cited by this paper
• Temporal trends in the treatment of pediatric type 1 diabetes and impact on acute outcomes.

  2007cited by this paper
• Continuing Stability of Center Differences in Pediatric Diabetes Care: Do Advances in Diabetes Treatment Improve Outcome?

  2007cited by this paper
• Assessment and monitoring of glycemic control in children and adolescents with diabetes

  2007cited by this paper
• Diabetes care provision and glycaemic control in Northern Ireland: a UK regional audit

  2005cited by this paper
• The impact of a decade of changing treatment on rates of severe hypoglycemia in a population-based cohort of children with type 1 diabetes.

  2004influential reference
• Predictors of glycaemic control and hypoglycaemia in children and adolescents with type 1 diabetes from NSW and the ACT

  2002cited by this paper
• Persistent differences among centers over 3 years in glycemic control and hypoglycemia in a study of 3,805 children and adolescents with type 1 diabetes from the Hvidøre Study Group.

  2001cited by this paper
• Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes.

  2001influential reference
• Factors influencing glycemic control young people with type 1 diabetes in Scotland: A population-based study (DIABAUD2)

  2001cited by this paper
• Perzentile für den Body-mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben

  2001cited by this paper
• Factors influencing glycemic control in young people with type 1 diabetes in Scotland: a population-based study (DIABAUD2).

  2001cited by this paper
• Factors associated with glycemic control. A cross-sectional nationwide study in 2,579 French children with type 1 diabetes. The French Pediatric Diabetes Group.

  1998cited by this paper
• Factors Associated With Glycemic Control: A cross-sectional nationwide study in 2,579 French children with type 1 diabetes

  1998cited by this paper
• The Diabetes Control and Complications Trial

  1998cited by this paper
• Comparison of Metabolic Control in a Cross-Sectional Study of 2,873 Children and Adolescents With IDDM from 18 Countries

  1997cited by this paper
• Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group.

  1994cited by this paper
• The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.

  1993cited by this paper
• Smoothing reference centile curves: the LMS method and penalized likelihood.

  1992cited by this paper
• Factors Influencing Glycemic Control in Young People With Type 1 Diabetes in Scotland

  year unknowncited by this paper

• Is the Current Screening Availability for Early Stages of Type 1 Diabetes in Germany Related to the Population‐Based Frequency of Diabetic Ketoacidosis at Clinical Manifestation in Children and Adolescents

  2026cites this paper
• Age-Dependent Bolus Settings: Insulin-to-Carbohydrate Ratios and Insulin Sensitivity Factors in Pediatric Patients with Type 1 Diabetes on Conventional CSII in the DPV Registry

  2025cites this paper
• Remission Period in Children With Newly Diagnosed Type 1 Diabetes During the COVID-19 Pandemic-Results From the DPV Registry

  2025cites this paper
• Heterogeneity in response to GLP-1 receptor agonists in type 2 diabetes in real-world clinical practice: insights from the DPV register – an IMI-SOPHIA study

  2025cites this paper
• Nonpharmacological interventions on glycated haemoglobin in youth with type 1 diabetes: a Bayesian network meta-analysis

  2024cites this paper
• Investigation on structural, electrical and magnetic properties of polycrystalline La0.6Dy0.2Ca0.2MnO3

  2024cites this paper
• Psychosocial Burden During the COVID-19 Pandemic in Adolescents With Type 1 Diabetes in Germany and Its Association With Metabolic Control.

  2024cites this paper
• Recent Improvements in Attainment of the Hemoglobin A1c Target of ≤7.0% Among Adults with Type 1 Diabetes in Ontario: A Retrospective Cohort Study

  2024cites this paper
• Factors associated with diabetic foot ulcers and lower limb amputations in type 1 and type 2 diabetes supported by real‐world data from the German/Austrian DPV registry

  2024cites this paper
• A Non-Toxic Binuclear Vanadium(IV) Complex as Insulin Adjuvant Improves the Glycemic Control in Streptozotocin-Induced Diabetic Rats

  2024cites this paper
• Clinical characteristics, treatment, and treatment switch after molecular‐genetic classification in individuals with maturity‐onset diabetes of the young: Insights from the multicenter real‐world DPV registry

  2024cites this paper
• Clinical Outcomes in Pediatric Patients With Type 1 Diabetes With Early Versus Late Diagnosis: Analysis From the DPV Registry.

  2024cites this paper
• The Association of Sociodemographic Factors and Utilization of Diabetes Technologies with Diabetes Management: An Investigation in Children and Adolescents with Type 1 Diabetes

  2024cites this paper
• BMI Z-Score (SDS) versus Calculated Body Fat Percentage: Association with Cardiometabolic Risk Factors in Obese Children and Adolescents

  2023cites this paper
• 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?

  2023cites this paper
• Metabolic control during the first two years of the COVID-19 pandemic in pediatric patients with type 1 diabetes: results from the German DPV initiative

  2023cites this paper
• Family structures and parents’ occupational models: its impact on children’s diabetes

  2023cites this paper
• Comparison of BMI and HbA1c changes before and during the COVID-19 pandemic in type 1 diabetes: a longitudinal population-based study

  2023cites this paper
• Time trends towards earlier puberty in boys and girls with type 1 diabetes: Insights from the German Diabetes Prospective Follow‐up (DPV) registry, 2000 to 2021

  2023cites this paper
• Managing Severe Hypoglycaemia in Patients with Diabetes: Current Challenges and Emerging Therapies

  2023cites this paper
• Frequency and characteristics of diabetes in lipodystrophies and insulin receptoropathies compared with type 1 and type 2: results from the multicenter DPV registry

  2023cites this paper
• Posttraumatic stress disorder and diabetes-related outcomes in patients with type 1 diabetes

  2023cites this paper
• Changes in cardiovascular risk factors among children and young adults with type 1 diabetes during the COVID‐19 pandemic compared to previous years—Results from the German DPV registry

  2023cites this paper
• Sociodemographic factors affecting glycaemic control in Finnish paediatric patients with type 1 diabetes

  2023cites this paper
• Predictors of glycemic control in children and adolescents with type 1 diabetes at 12 months after diagnosis

  2022cites this paper
• Awareness of Parents Regarding DKA Symptoms in their Children with Type I DM

  2022cites this paper
• Entwicklung der Rehabilitation von Kindern und Jugendlichen mit Diabetes während der Corona-Pandemie im Vergleich zum Vor-Pandemiejahr

  2022cites this paper
• Stable Metabolic Control but Increased Demand for Professional Support in Children with Type 1 Diabetes in the Past Ten Years in Bern/Switzerland: A Quality Control Study

  2022cites this paper
• ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes education in children and adolescents

  2022cites this paper
• Effects of exercise training on glycaemic control in youths with type 1 diabetes: A systematic review and meta-analysis of randomised controlled trials

  2022cites this paper
• Metabolic control during the SARS‐CoV‐2 lockdown in a large German cohort of pediatric patients with type 1 diabetes: Results from the DPV initiative

  2022cites this paper
• Dynamics of Hemoglobin A1c, Body Mass Index, and Rates of Severe Hypoglycemia in 4434 Adults with Type 1 or Type 2 Diabetes After Initiation of Continuous Glucose Monitoring

  2022cites this paper
• Cataract in children and adolescents with type 1 diabetes. Insights from the German/Austrian DPV registry

  2022cites this paper
• Diagnosis, Therapy and Follow-Up of Diabetes Mellitus in Children and Adolescents.

  2022cites this paper
• Trends in Glycemia between 2002 and 2016 among Incident Youth Cohorts Early in the Course of Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

  2022cites this paper
• Personality, Coping and Developmental Conditions in Female Adolescents and Young Adults with Type 1 Diabetes: Influence on Metabolic Control and Quality of Life

  2022cites this paper
• Advancements and future directions in the teamwork, targets, technology, and tight control—the 4T study: improving clinical outcomes in newly diagnosed pediatric type 1 diabetes

  2022cites this paper
• Reductions in HbA1c with Flash Glucose Monitoring Are Sustained for up to 24 Months: A Meta-Analysis of 75 Real-World Observational Studies

  2022influential citation
• The Relationship between Selected Inflammation and Oxidative Stress Biomarkers and Carotid Intima-Media Thickness (IMT) Value in Youth with Type 1 Diabetes Co-Existing with Early Microvascular Complications

  2022cites this paper
• Early vs late histological confirmation of coeliac disease in children with new-onset type 1 diabetes

  2022cites this paper
• Suboptimal glycemic control in adolescents and young adults with type 1 diabetes from 2011 to 2020 across Australia and New Zealand: Data from the Australasian Diabetes Data Network registry

  2022cites this paper
• Frequency of Ketoacidosis at Diagnosis of Pediatric Type 1 Diabetes Associated With Socioeconomic Deprivation and Urbanization: Results From the German Multicenter DPV Registry.

  2022cites this paper
• Non-suicidal self-injury in adolescents and young adults with type 1 diabetes: clinical characteristics from a German diabetes-patient registry (DPV).

  2021cites this paper
• Previous diabetic ketoacidosis as a risk factor for recurrence in a large prospective contemporary pediatric cohort: Results from the DPV initiative

  2021cites this paper
• 13. Children and Adolescents: Standards of Medical Care in Diabetes-2021.

  2021cites this paper
• Declining Frequency of Acute Complications Associated with Tubeless Insulin Pump Use: Data from 2,911 Patients in the German/Austrian Diabetes Patienten Verlaufsdokumentation Registry

  2021cites this paper
• Association of the use of diabetes technology with HbA1c and BMI‐SDS in an international cohort of children and adolescents with type 1 diabetes: The SWEET project experience

  2021cites this paper
• Effect of an Integrated, Multidisciplinary Nationwide Approach to Type 1 Diabetes Care on Metabolic Outcomes: An Observational Real-World Study

  2021cites this paper
• Patterns of insulin therapy and insulin daily doses in children and adolescents with type 1 diabetes in Germany

  2021cites this paper
• Relationship Between the Levels of 25-hydroxyvitamin D at Presentation and the Clinical, Laboratory and Follow-up Data of Children and Adolescents with Type-1 Diabetes Mellitus

  2021cites this paper
• Angst und Depression bei Typ-1-Diabetes – Erste Ergebnisse des Screenings auf psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen im Rahmen des COACH-Konsortiums

  2021cites this paper
• 14. Children and Adolescents: Standards of Medical Care in Diabetes-2022.

  2021cites this paper
• Diabetes in Youth: A Global Perspective.

  2021cites this paper
• Idiopathic Frozen Shoulder in Individuals with Diabetes: Association with Metabolic Control, Obesity, Antidiabetic Treatment and Demographic Characteristics in Adults with Type 1 or 2 Diabetes from the DPV Registry.

  2021cites this paper
• Changes in HbA1c Between 2011 and 2017 in Germany/Austria, Sweden, and the United States: A Lifespan Perspective

  2021cites this paper
• Heterogeneity of Access to Diabetes Technology Depending on Area Deprivation and Demographics Between 2016 and 2019 in Germany

  2021cites this paper
• Zusammenhang von Bildungsstatus und Diabetesoutcomes: Ergebnisse der DIAS-Studie bei Kindern und Jugendlichen mit Typ-1-Diabetes in Deutschland

  2021cites this paper
• Akutkomplikationen

  2021cites this paper
• Not All Type-2-Diabetes Patients Increase Body Mass Index After Initiating Insulin: Results of Latent Class Analysis from the DPV Registry

  2021cites this paper
• Longitudinal relationship of particulate matter and metabolic control and severe hypoglycaemia in children and adolescents with type 1 diabetes.

  2021cites this paper
• Frequency of Autoantibody-Negative Type 1 Diabetes in Children, Adolescents, and Young Adults During the First Wave of the COVID-19 Pandemic in Germany

  2021cites this paper
• Personal Glycation Factors and Calculated Hemoglobin A1c for Diabetes Management: Real-World Data from the Diabetes Prospective Follow-up (DPV) Registry

  2021cites this paper
• The Association between Treatment Modality, Lipid Profile, Metabolic Control in Children with Type 1 Diabetes and Celiac Disease—Data from the International Sweet Registry

  2021cites this paper
• Association of socio-demographic and anthropometric characteristics with the management and glycemic control in type 1 diabetic children from the province of El Jadida (Morocco)

  2021cites this paper
• Size matters - influence of center size on quality of diabetes control in children and adolescents with type 1 diabetes: A longitudinal analysis of the DPV cohort.

  2021cites this paper
• Bone Fractures in Children and Young Adults With Type 1 Diabetes: Age Distribution, Fracture Location, and the Role of Glycemic Control

  2021cites this paper
• Development and validity testing of a type 1 diabetes resource for 10-19-years old adolescents in China.

  2021cites this paper
• Comparison of cardiovascular risk factors between children and adolescents with classes III and IV obesity: findings from the APV cohort

  2021cites this paper
• The Impact of Racial and Ethnic Health Disparities in Diabetes Management on Clinical Outcomes: A Reinforcement Learning Analysis of Health Inequity Among Youth and Young Adults in the SEARCH for Diabetes in Youth Study.

  2021cites this paper
• Hospitalization for hypoglycaemia in people with diabetes in Denmark, 1997–2017: Time trends in incidence and HbA1c and glucose‐lowering drug use before and after hypoglycaemia

  2021cites this paper
• Characteristics of patients with type 1 diabetes and additional autoimmune disease in the DPV registry.

  2021cites this paper
• Intermittently Scanned Continuous Glucose Monitoring Data of Polish Patients from Real-Life Conditions: More Scanning and Better Glycemic Control Compared to Worldwide Data

  2021cites this paper
• Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter

  2021cites this paper
• Are psychiatric disorders associated with thyroid hormone therapy in adolescents and young adults with type 1 diabetes?

  2020cites this paper
• Early versus delayed insulin pump therapy in children with newly diagnosed type 1 diabetes: results from the multicentre, prospective diabetes follow-up DPV registry.

  2020cites this paper
• Demographic characteristics and acute complications among adults with type 1 diabetes: Comparison of two multicentre databases from Germany and the United States.

  2020cites this paper
• Impact of deprivation on glycaemic control in youth with type 1 diabetes in the southwestern region of France

  2020cites this paper
• Use of insulin pump therapy is associated with reduced hospital-days in the long-term: a real-world study of 48,756 pediatric patients with type 1 diabetes

  2020cites this paper
• Familienzeit als Schutzfaktor für emotionale Probleme und Verhaltensprobleme von Kindern und Jugendlichen mit Diabetes mellitus Typ 1

  2020cites this paper
• Effect of CGM in the HbA1c and Coefficient of Variation of glucose in a pediatric sample.

  2020cites this paper
• Predicting healthcare utilization in youth with type 1 diabetes: The importance of family level variables

  2020cites this paper
• The Transatlantic HbA1c gap: differences in glycaemic control across the lifespan between people included in the US T1D Exchange Registry and those included in the German/Austrian DPV registry

  2020cites this paper
• A Decade of Disparities in Diabetes Technology Use and HbA1c in Pediatric Type 1 Diabetes: A Transatlantic Comparison

  2020cites this paper
• Five years of improving diabetes control in Czech children after the establishment of the population‐based childhood diabetes register ČENDA

  2020cites this paper
• Comparing diabetes due to diseases of the exocrine pancreas to type 1 and type 2 diabetes using propensity score matching.

  2020cites this paper
• Fracture risk in patients with type 2 diabetes aged ≥50 years related to HbA1c, acute complications, BMI and SGLT2i-use in the DPV registry.

  2020cites this paper
• Improving Clinical Outcomes in Newly Diagnosed Pediatric Type 1 Diabetes: Teamwork, Targets, Technology, and Tight Control—The 4T Study

  2020cites this paper
• Knowledge about Diabetic Ketoacidosis among Parents of Type 1 Diabetic Children

  2020cites this paper
• Type 1 diabetes and epilepsy in childhood and adolescence: Do glutamic acid decarboxylase autoantibodies play a role? Data from the German/Austrian/Swiss/Luxembourgian DPV Registry

  2020cites this paper
• International benchmarking in type 1 diabetes: Large difference in childhood HbA1c between eight high‐income countries but similar rise during adolescence—A quality registry study

  2020cites this paper
• Undertreatment of Cardiovascular Risk factors in the Type 1 Diabetes Exchange Clinic Network (USA) and the Prospective Diabetes Follow-up (Germany/Austria) Registries.

  2020cites this paper
• Children with onset-ketoacidosis are admitted to the nearest hospital available, regardless of center size

  2020cites this paper
• A Comparison of Familial and Sporadic Type 1 Diabetes Among Young Patients

  2020cites this paper
• Th2-Immune Polarizing and Anti-Inflammatory Properties of Insulin Are Not Effective in Type 2 Diabetic Pregnancy

  2020cites this paper
• Intermittently Scanned Glucose Values for Continuous Monitoring: Cross-Sectional Analysis of Glycemic Control and Hypoglycemia in 1809 Children and Adolescents with Type 1 Diabetes

  2020cites this paper
• Is there an optimal strategy for real‐time continuous glucose monitoring in pediatrics? A 12‐month French multi‐center, prospective, controlled randomized trial (Start‐In!)

  2019cites this paper
• Diabetes mellitus Typ 1 bei Kindern und Jugendlichen: Stoffwechselkontrolle und Folgeerkrankungen

  2019cites this paper
• 13. Children and Adolescents: Standards of Medical Care in Diabetes−2020

  2019cites this paper
• Impact of Socioeconomic Characteristics on Metabolic Control in Children with Type 1 Diabetes in a Developing Country

  2019cites this paper
• Lipid profile is associated with treatment regimen in a large cohort of children and adolescents with Type 1 diabetes mellitus: a study from the international SWEET database

  2019cites this paper