European Journal of Endocrinology
Volume 181, Issue 1, 2019, Pages 31-38

Diabetes care in pediatric refugees from Africa or Middle East: Experiences from Germany and Austria based on real-world data from the DPV registry (Article)

Prinz N.* , Konrad K. , Brack C. , Hahn E. , Herbst A. , Icks A. , Grulich-Henn J. , Jorch N. , Kastendieck C. , Mönkemöller K. , Razum O. , Steigleder-Schweiger C. , Witsch M. , Holl R.W. , Lanzinger S. , Hungele A. , Ranz R. , Fink K. , Bollow E. , DPV Initiative
  • a Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany, German Center for Diabetes Research (DZD), Munich Neuherberg, Germany
  • b Department of Pediatric and Adolescent Medicine, University of Cologne, Cologne, Germany, Department of Pediatric and Adolescent Medicine, Elisabeth-Hospital Essen, Essen, Germany
  • c Pediatric Practice, Celle, Germany
  • d Department of Pediatrics and Adolescent Medicine, Protestant Hospital Oberhausen, Oberhausen, Germany
  • e Department of Pediatric and Adolescent Medicine, Hospital Leverkusen gGmbH, Leverkusen, Germany
  • f German Center for Diabetes Research (DZD), Munich Neuherberg, Germany, Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany, Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
  • g Department of Pediatrics, University of Heidelberg, Heidelberg, Germany
  • h Department of Pediatrics, Protestant Hospital Bielefeld gGmbH, Bielefeld, Germany
  • i Department of Pediatrics, Clinic Bremen-Mitte, Bremen, Germany
  • j Department of Pediatrics, Pediatric Hospital, Amsterdamer Straße, Cologne, Germany
  • k School of Public Health, Bielefeld University, Bielefeld, Germany
  • l Department of Pediatrics, University Hospital of Pediatrics, Paracelsus Medical University Salzburg, Salzburg, Austria
  • m Department of Pediatric and Adolescent Medicine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
  • n Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany, German Center for Diabetes Research (DZD), Munich Neuherberg, Germany
  • o University of Ulm, Germany
  • p University of Ulm, Germany
  • q University of Ulm, Germany
  • r University of Ulm, Germany
  • s University of Ulm, Germany
  • t [Affiliation not available]

Abstract

Objective: With increasing migration to Europe, diabetes diagnosis and treatment of refugees became challenging. To describe the current experience with pediatric refugees in Germany and Austria. Design and Methods: 43,137 patients (<21 years) with type 1 diabetes from the diabetes patient follow-up registry (DPV) were studied and divided by refugee status into patients born in Middle East (n = 365) or Africa (n = 175) and native patients (child and parents born in Germany/Austria; G/A: n = 42,597). Groups were compared using multivariable regression adjusted for age, sex and diabetes duration (SAS 9.4). In refugees the first year after arrival was studied, and for native children the most recent year of care. Results: After adjustment, HbA1c was highest in refugees (1. ME and 2. AFR vs 3. G/A: 72.3 ± 1.0 and 75.0 ± 1.4 vs 66.0 ± 0.1 mmol/mol, 1 vs 3: P < 0.001 and 2 vs 3: P < 0.001) and microalbuminuria (9.9 and 13.6 vs 6.5%, 1 vs 3: P = 0.039 and 2 vs 3: P = 0.002) was more prevalent. African children experienced severe hypoglycemia (17.8 ± 4.3 and 25.4 ± 8.7 vs 11.5 ± 0.3 per 100 patient years, 1 vs 3: P > 0.05 and 2 vs 3: P = 0.045) significantly more often, whereas hypoglycemia with coma (5.1 ± 1.1 and 4.1 ± 1.6 vs 2.6 ± 0.1 per 100 patient years, 1 vs 3: P = 0.006 and 2 vs 3: P > 0.05) and retinopathy (2.1 and n/a vs 0.2%, 1 vs 3: P < 0.001) were significantly more common in children from Middle East compared to natives. Insulin pumps were used in a markedly larger proportion of native patients (7.4 and 13.2 vs 43.0%, 1 vs 3: P < 0.001 and 2 vs 3: P < 0.001). Conclusions: A relevant number of pediatric refugees with type 1 diabetes are treated in German/Austrian diabetes clinics. Refugee children, parents and caregivers are faced with several problems in diabetes therapy and outcome that should be addressed more intensively by pediatric diabetes teams. © 2019 European Society of Endocrinology Printed in Great Britain

Author Keywords

[No Keywords available]

Index Keywords

antidiabetic agent thalassemia Germany refugee regression analysis Registries Diabetic Retinopathy insulin dependent diabetes mellitus diabetic complication multivariate logistic regression analysis non insulin dependent diabetes mellitus register follow up human Refugees Middle East priority journal hypertension microalbuminuria Austria hemoglobin A1c protein, human ethnology hemoglobin A1c diabetic patient insulin Diabetes Mellitus, Type 1 Humans Hypoglycemic Agents glycosylated hemoglobin Treatment Outcome Adolescent male glycemic control treatment indication female Multivariate Analysis Africa Down syndrome hypoglycemia Article blood Glycated Hemoglobin A major clinical study adult pediatric patient dyslipidemia insulin treatment glucose diabetic ketoacidosis anthropometry metabolic regulation genetic disorder coma exocrine pancreatic insufficiency Child
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85068847390&doi=10.1530%2fEJE-18-0898&partnerID=40&md5=008dc7e798318d1e8b28f719ea05eb36
DOI: 10.1530/EJE-18-0898
ISSN: 08044643
Original Language: English