Rehabilitation in Germany 2004–2016 A Multicenter Analysis Over a Period of 13 Years in Children and Adolescents with Diabetes Mellitus

Abstract

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. Methods: 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). Results: 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). Conclusions: 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.

Key words

rehabilitation - HbA1c - education - insulin - diabetes mellitus - children

• References

• 1 Warren MD. The need for rehabilitation. In: Mattingly S. (eds.) Rehabilitation today. Springer; Dordrecht, The Netherlands: 1977
• 2 NIH Medical Rehabilitation Coordinating Committee. O’Mara A, Rowland JH, Greenwell TN. et al. National institutes of health research plan on rehabilitation: NIH Medical Rehabilitation Coordinating Committee. Phys Ther 2017; 97: 104-407
• 3 Deutsche Rentenversicherung. Reha-Bericht 2015. http://www.deutsche-rentenversicherung.de/Allgemein/de/Inhalt/6_Wir_ueber_uns/03_fakten_und_zahlen/03_statistiken/02_statistikpublikationen/02_rehabericht_2015.pdf?__blob = publicationFile&v = 4, 2015; 27.01.2017
• 4 Stachow R, Schiel R, Koch R. et al. Effekte der stationären Rehabilitation von Kindern und Jugendlichen mit Diabetes mellitus Typ 1. Monatsschr Kinderheilkd 2013; 161: 727-734
• 5 Deutsche Diabetes Gesellschaft (DDG), Deutsche Diabetes Hilfe (diabetesDE). Deutscher Gesundheitsbericht. Diabetes 2016. https://www.diabetesde.org/system/files/documents/fileadmin/users/Patientenseite/PDFs_und_TEXTE/Infomaterial/Gesundheitsbericht_2016.pdf , 2016; 23.06.2017
• 6 Widera T, Baumgarten E, Beckmann U. et al. Kinder- und Jugendlichen-Rehabilitation – Versorgung und Versorgungsqualität. RVaktuell 2011; 1: 20-28
• 7 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). S2-Leitlinie Rehabilitation Diabetes mellitus in der Kinder- und Jugendmedizin. http://www.awmf.org/uploads/tx_szleitlinien/070-003k_S2_Diabetes_mellitus_stationaere_Rehabilitation.pdf , 2007; 10.08.2016
• 8 American Diabetes Association. The Expert Committee on the Diagnosis and Classification of Diabetes mellitus: Report of the Expert Committee on the Diagnosis and Classification of Diabetes mellitus. Diabetes Care 20 1997; 1183-1197
• 9 Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter (AGA). Leitlinien. Verabschiedet auf der Konsensus-Konferenz der AGA am 10.09.04. http://www.a-g-a.de 2004; 04.04.2013
• 10 Guidelines Subcommittee. 1999 World Health Organization – International society of hypertension guidelines for the management of hypertension. J Hyperten 1999; 17: 151-183
• 11 The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977-986
• 12 Neu A, Feldhahn L, Ehehalt S. et al. No change in type 2 diabetes prevalence in children and adolescents over 10 years: Update of a population-based survey in South Germany. Pediatr Diabetes 2017;
• 13 Deutsche Diabetes Gesellschaft. Anerkannte Schulungs- und Behandlungsprogramme nach den Richtlinien der Deutschen Diabetes Gesellschaft (DDG). http://www.deutsche-diabetes-gesellschaft.de/fileadmin/Redakteur/Zertifizierung/Schulungsprogramme/Liste_anerkannter_Schulungs-_und_Behandlungsprogramme_DDG_2016_1.pdf. 2016; 05.02.2017
• 14 Bortz J. Statistik für Sozialwissenschaftler. Berlin, Germany: Springer Verlag; 2005: 6 Edition
• 15 Neu A, Beyer P, Bürger-Büsing J. et al. Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. In: Kellerer M, Gallwitz B, im Auftrag der DDG. Praxisempfehlungen der Deutschen Diabetes Gesellschaft Diabetologie 2015; 10: S181-S191
• 16 Maffi P, Secchi A. The Burden of Diabetes: Emerging Data. Dev Ophthalmol 2017; 60: 1-5
• 17 Svensson J, Cerqueira C, Kjærsgaard P. et al. Danish Registry of Childhood and Adolescent Diabetes. Clin Epidemiol 2016; 8: 679-683
• 18 Stachow R, Pankatz M, Burmester H. et al. Motivationsförderung in der Patientenschulung von Jugendlichen mit Diabetes mellitus Typ 1. Pädiatrische Praxis 2015; 84: 237-252
• 19 Olsen B, Johannesen J, Fredheim S. et al. Danish society for childhood and adolescent diabetes. Insulin pump treatment; increasing prevalence, and predictors for better metabolic outcome in Danish children and adolescents with type 1 diabetes. Pediatr Diabetes 2015; 16: 256-262
• 20 Redon I, Beltrand J, Martin D. et al. AJD health care teams. Changes in insulin therapy regimens over 10 yr in children and adolescents with type 1 diabetes attending diabetes camps. Pediatr Diabetes 2014; 15: 329-335
• 21 Holl R., Prinz N für das DPV-Register der pädiatrischen Diabetologie. Medizinische Versorgung von Kindern und Jugendlichen mit Diabetes – Entwicklungen der letzten 21 Jahre. In: Deutsche Diabetes-Gesellschaft, diabetesDE Deutsche Diabetes Hilfe (Hrsg.). Deutscher Gesundheitsbericht Diabetes 2017. http://www.diabetesde.org/system/files/documents/ gesundheitsbericht_2017.pdf 31.01.2017
• 22 Rabbone I, Barbetti F, Marigliano M. et al. Successful treatment of young infants presenting neonatal diabetes mellitus with continuous subcutaneous insulin infusion before genetic diagnosis. Acta Diabetol. 2016; 53: 559-565
• 23 Malik FS, Taplin CE. Insulin therapy in children and adolescents with type 1 diabetes. Paediatr Drugs 2014; 16: 141-150
• 24 Misso ML, Egberts KJ, Page M. et al. Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus. Cochrane Database Syst Rev. 2010; CD005103 10.1002/14651858.CD005103.pub2 31.01.2017
• 25 Tubiana-Rufi N. Insulin pump therapy in neonatal diabetes. Endocr Dev 2007; 12: 67-74
• 26 Shalitin S, Peter Chase H. Diabetes technology and treatments in the paediatric age group. Int J Clin Pract Suppl 2011; 170: 76-82
• 27 Health Quality Ontario. Continuous subcutaneous insulin infusion (CSII) pumps for type 1 and type 2 adult diabetic populations: An evidence-based analysis. Ont Health Technol Assess Ser 2009; 9: 1-58
• 28 Kaiserman K, Jung H, Benabbad I. et al. 20 Years of insulin lispro in pediatric type 1 diabetes: a review of available evidence. Pediatr Diabetes 2016; 31.01.2017
• 29 Riemsma R, Corro Ramos I, Birnie R. et al. Integrated sensor-augmented pump therapy systems [the MiniMed® Paradigm™ Veo system and the Vibe™ and G4® PLATINUM CGM (continuous glucose monitoring) system] for managing blood glucose levels in type 1 diabetes: A systematic review and economic evaluation. Health Technol Assess 2016; 20: 1-251
• 30 Matsuda E, Brennan P. The effectiveness of continuous subcutaneous insulin pumps with continuous glucose monitoring in outpatient adolescents with type 1 diabetes: A systematic review. JBI Libr Syst Rev 2012; 10: S1-S10
• 31 Karges B, Schwandt A, Heidtmann B. et al. Association of insulin pump therapy vs insulin injection therapy with severe hypoglycemia, ketoacidosis, and glycemic control among children, adolescents, and young adults with type 1 diabetes. JAMA 2017; 318: 1358-1366
• 32 Kadiri A, Al-Nakhi A, El-Ghazali S. et al. Treatment of type 1 diabetes with insulin lispro during Ramadan. Diabetes Metab 2001; 27: 482-486
• 33 Shehadeh N, Maor Y. Ramadan Study Group. Effect of a new insulin treatment regimen on glycaemic control and quality of life of Muslim patients with type 2 diabetes mellitus during Ramadan fast - an open label, controlled, multicentre, cluster randomised study. Int J Clin Pract 2015; 69: 1281-1288
• 34 Tsiouli E, Alexopoulos EC, Stefanaki C. et al. Effects of diabetes-related family stress on glycemic control in young patients with type 1 diabetes: Systematic review. Can Fam Physician 2013; 59: 143-149