OBJECTIVE:Celiac disease (CD) is a common comorbidity of type 1 diabetes (T1D). Long-term consequences of CD are not completely understood, and adhering to a gluten-free diet is a burden for many patients. We investigated the effect of CD on vascular risk factors in a large cohort of T1D patients aged <20 yr.RESEARCH DESIGN AND METHODS:Within the longitudinal Diabetes Patienten Verlaufsdokumentation (DPV)-diabetes registry, data were analyzed from 59,909 < 20-yr-old T1D patients treated at 392 centers in Germany and Austria. A total of 974 patients with biopsy-proven celiac disease (BPCD) were compared with 28,398 patients without CD with respect to blood pressure (BP), lipids, glycohemoglobin (HbA1c ), body mass index (BMI), and reported smoking behavior.RESULTS:Patients with T1D and BPCD showed significantly lower high-density lipoprotein (HDL) cholesterol levels [median (interquartile range): 53.0 (43.0-62.6) mg/dL] than patients without CD [55.0 (45.0-66.0) mg/dL; p < 0.01; p < 0.001 after adjustment for confounding variables]. Systolic BP was lower in patients with CD [105.5 (100.0-112.5) mmHg] than in patients without CD [110.0 (102.0-117.0) mmHg; p < 0.0001; p < 0.001 after adjustment]. There were no significant differences regarding smoking behavior, BMI, or HbA1c . In a subgroup of 335 patients with BPCD, HDL cholesterol was measured 1 yr after diagnosis of CD:HDL increased by 8% (p < 0.01).CONCLUSION:Young people with T1D and CD have lower HDL cholesterol values than patients without CD. As low HDL cholesterol is associated with vascular risk, our findings support screening for CD and monitoring of HDL cholesterol in young people with T1D.

Background In type 1 diabetes (T1D), the use of continuous subcutaneous insulin infusion (CSII) has increased steadily in the last years. Compared with conventional insulin injection regimes, major advantages might be a nearly physiological insulin secretion, lower rates of hypoglycemia, higher flexibility in daily life, and increased quality of life. Data on CSII in cystic fibrosis-related diabetes (CFRD) are scarce. Objective To analyze current use of insulin pumps in CFRD and compare demographics of pump-treated patients between CFRD and T1D. Methods Data from the prospective German/Austrian diabetes patient registry on insulin-treated patients with either CFRD (n = 515) or T1D (n = 43 165) aged >10 yr at manifestation of diabetes were analyzed. Results A total of 4.1% (n = 21) of CFRD and 17.7% (n = 7647) of T1D patients received insulin pump treatment within the recent year of care (p < 0.001). Pump-treated patients with CFRD had a significantly shorter duration of diabetes [median (Q1; Q3): 5.8 (2.9; 9.5) vs. 7.8 (4.3; 20.4) yr, p = 0.026] and tended to be younger [22.0 (18.2; 30.1) vs. 24.9 (17.3; 45.9) yr] than pump-treated T1D patients. Age at initiation of CSII seemed to be lower in CFRD [19.2 (16.5; 29.2) vs. 23.3 (14.8; 43.5) yr]. Insulin pump therapy was used slightly more often in male CFRD patients than females (4.7 vs. 3.6%), whereas in T1D the opposite was observed (14.9 vs. 21.2%, p < 0.001). Discontinuation rate of CSII was higher in CFRD than T1D (30.0 vs. 12.7%, p = 0.005). Conclusions Despite potential advantages, insulin pump therapy was rarely used among adolescent and young adult CFRD patients.

Percentile-based non-high-density lipoprotein cholesterol levels were analyzed by glycemic control, weight, age, and sex of children with type 1 diabetes (n = 26,358). Ten percent of all children and 25% of overweight adolescent girls require both immediate lipid-lowering medication and lifestyle changes to achieve non-high-density lipoprotein cholesterol levels <120 mg/dL and cardiovascular risk reduction.

Vorangegangene Studien weisen darauf hin, dass es sich bei CF-bezogenem Diabetes (cystic fibrosis-related diabetes, CFRD) um eine separate klinische Entität handelt. Da hier nicht alle Betazellen des Pankreas vernichtet wurden, bleibt eine gewisse endogene Insulinsekretion erhalten. Scheuing et al. haben in einer Studie untersucht, ob sich die tägliche Kohlenhydrataufnahme und -verteilung sowie der Insulinbedarf bei Patienten mit CFRD und Typ-1-Diabetes unterscheiden.

AIM:Children and adolescents with a molecular diagnosis of HNF1A-MODY should be treated with oral sulfonylurea according to current International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines.METHODS:We surveyed the German-Austrian DPV database of 50 043 people and included 114 patients with a confirmed molecular-genetic diagnosis of HNF1A mutation and diabetes onset at below age 18 years. We analysed hypoglycaemic episodes, metabolic control (HbA1c ) and other clinical variables according to treatment groups.RESULTS:People with HNF1A-MODY were included and analysed according to treatment with insulin alone (n = 34), sulfonylurea (n = 30), meglitinides (n = 22) or lifestyle (n = 28). In those receiving any drug treatment (n = 86), severe hypoglycaemia did not occur with meglitinide and was highest (at 3.6 events per 100 patient-years) with insulin. HbA1c was highest with insulin treatment (insulin = 58 mmol/mol, 7.5%; sulfonylurea = 55 mmol/mol, 7.2%; meglitinides = 52 mmol/mol, 6.9%; P = 0.008), whereas weight (BMI SD score), serum lipids and blood pressure were not different.CONCLUSIONS:Of note, 40% of people with HNF1A-MODY and medical treatment were receiving insulin alone and thus were not being treated in line with up-to-date International Society for Pediatric and Adolescent Diabetes/International Diabetes Federation guidelines, despite insulin treatment being associated with worse metabolic control and the risk of hypoglycaemia. The unlicensed use of oral drugs in patients below age 18 years and adherence by both doctors and patients to the initial insulin treatment might contribute to this finding.

To investigate whether celiac disease (CD) associated with type 1 diabetes increases the risk of microvascular complications.

Fragestellung: In unserer alternden Gesellschaft treten Demenz und Typ-2-Diabetes (T2D) immer häufiger auf. Ziel war es den Einfluss einer komorbiden Demenzdiagnose auf die Diabetestherapie und den Verlauf zu untersuchen.

Background and aims: A bidirectional relationship between type 2 diabetes (T2D) and depressive symptoms has been reported. The primary aim was to analyze predictors of depressed mood in T2D. Secondly, the odds ratio of developing a clinically recognized depression in patients with conspicuous screening result was evaluated. Materials and methods: 35,691 T2D patients aged ≥18 years (median [IQR]: 68.9 [59.2-76.5] years) from the German/Austrian multicenter prospective diabetes follow-up registry (DPV) were analyzed. All patients had completed the WHO-5 questionnaire, a reliable and validated 5-item screening tool for depression (score ≤7: likely depression). Logistic regression modeling (SAS 9.4) was applied to study potential predictors (e.g. demographics, regional aspect, diabetes therapy, glycemic S414 Diabetologia (2015) 58 (Suppl 1):S1–S607 control) for depressed mood as well as the risk of developing clinically recognized depression. Results: Depressed mood was present in 11.2% (n=4,000) of patients screened and thereby significantly more prevalent compared to the adult German population (DEGS study: 8.1%, p<0.001). Patients with likely depression had a later diabetes onset (60.5 [49.6-70.2] vs. 58.3 [49.1- 67.7] years, p<0.001) and were more often female (54.0 vs. 48.0%, p< 0.001) compared to patients with inconspicuous results. Duration of diabetes did not differ significantly between groups (7.6 [2.4-12.9] vs. 7.0 [2.1-13.5] years, p=0.76). Young and very old age as well as female sex were associated with depressed mood (table 1, model 1). Moreover, living in northern federal states of Germany, poor glycemic control (HbA1c ≥58 mmol/mol) and insulin treatment were significantly related to depressed mood in T2D (table 1). Overall, the odds of developing a clinical diagnosis of depression was 1.95 (95%CI: 1.66-2.29) times higher in patients scored ≤7 in the WHO-5 questionnaire. Conclusion: Depressed mood is a frequent psychological comorbidity in adult T2D patients. In clinical care, routinely screening for psychological problems as recommended by guidelines is absolutely advisable, especially in high-risk patients.

OBJECTIVE To investigate whether celiac disease (CD) associated with type 1 diabetes increases the risk of microvascular complications. RESEARCH DESIGN AND METHODS Patients (n = 56,514) aged >10 years with diabetes duration <20 years from 392 centers in Germany and Austria were assigned to one of three categories (n): no CD (50,933), biopsy-confirmed CD (812), or suspected CD (4,769; clinical diagnosis or positive antibodies). The confirmed and suspected groups were combined and analyzed for retinopathy or nephropathy. Cox proportional hazards regression was used to adjust for potential confounders (glycated hemoglobin [HbA1c], age at diabetes onset, sex, smoking, dyslipidemia, and hypertension). RESULTS Kaplan-Meier analysis revealed that retinopathy and nephropathy occurred earlier in the presence versus absence of CD: retinopathy at age 26.7 years (95% CI 23.7–30.2) in 25% of patients with CD vs. age 33.7 years (33.2–34.4) in 25% without CD and microalbuminuria at age 32.8 years (29.7–42.5) vs. 42.4 years (41.4–43.3). The adjusted risk for both retinopathy (hazard ratio 1.263 [95% CI 1.078–1.481]) and nephropathy (1.359 [1.228–1.504]) was higher in patients with diabetes and CD versus those without CD. Cox regression revealed CD as an independent risk factor for microvascular complications after adjustment for confounders. CONCLUSIONS CD is an independent risk factor for retinopathy and nephropathy in patients with type 1 diabetes. Our study therefore supports the recommendation for regular serologic testing for CD, even in the absence of clinical CD. Further prospective studies are required to investigate whether a gluten-free diet might reduce the risk of microvascular disorders in patients with diabetes and CD.

OBJECTIVE:To study the impact of maternal country of birth on type-1-diabetes (T1D) therapy and outcome.STUDY DESIGN AND METHODS:27,643 T1D patients aged ≤20 years with documented maternal country of birth from the multicenter German/Austrian diabetes patient registry (DPV) were analyzed. Patients were categorized based on their mother's origin: Germany/Austria (reference), Turkey, Southern Europe, and Eastern Europe. To compare BMI standard deviation score (BMI-SDS), diabetes therapy and outcome between groups, multivariable regression was applied with adjustments for age, sex and duration of diabetes. Based on observed marginal frequencies, adjusted estimates were calculated. Linear regression was used for continuous data, logistic regression for binary data and Poisson regression for count data. All statistical analyses were performed using SAS 9.4. Significance was set at a two-tailed p<0.05.RESULTS:83.3% of patients were offspring of native mothers. A Turkish, Southern or Eastern European background was documented in 2.4%, 1.7% and 4.3% of individuals. After demographic adjustment, patients with migration background had a higher mean BMI-SDS (Turkey, Southern Europe or Eastern Europe vs. Germany/Austria: 0.58±0.03, 0.40±0.04, or 0.37±0.02 vs. 0.31±0.01; ±SE) and a lower use of insulin pumps (26.8%, 27.9%, or 32.6% vs. 37.9%) compared to offspring of native mothers. Mean HbA1c was worst in individuals of Turkish mothers (Turkey vs. Germany/Austria: 69.7±0.7 vs. 66.6±0.1 mmol/mol; ±SE). Patients of Eastern European descent had an increased rate of severe hypoglycemia (22.09±0.13 vs. 16.13±0.02 events per 100 patient-years) and ketoacidosis was more prevalent in offspring of Turkish or Southern European mothers (7.50±0.10, or 7.13±0.11 vs. 6.54±0.02 events per 100 patient-years). Patients of Turkish descent were more often hospitalized (57.2±2.7 vs. 48.5±0.4 per 100 patient-years). All differences were significant.CONCLUSION:The differences in diabetes therapy and outcome among patients with distinct migration background suggest that specific challenges have to be considered in clinical care.

Background This study analyzed the prevalence of and association between symptoms of eating disorders and depression in female and male emerging adults with early-onset, long-duration type 1 diabetes and investigated how these symptoms are associated with metabolic control. Methods In a nationwide population-based survey, 211 type 1 diabetes patients aged 18-21 years completed standardized questionnaires, including the SCOFF questionnaire for eating disorder symptoms and the Patient Health Questionnaire (PHQ-9) for symptoms of depression and severity of depressive symptoms (PHQ-9 score). Multiple linear and logistic regression models were used to analyze the association between eating disorder and depressive symptoms and their associations with HbA1c. Results A total of 30.2% of the women and 9.5% of the men were screening positive for eating disorders. The mean PHQ-9 score (standard deviation) was 5.3 (4.4) among women and 3.9 (3.6) among men. Screening positive for an eating disorder was associated with more severe depressive symptoms among women (βwomen 3.8, p<0.001). However, neither eating disorder symptoms nor severity of depressive symptoms were associated with HbA1c among women, while HbA1c increased with the severity of depressive symptoms among men (βmen 0.14, p=0.006). Conclusions Because of the high prevalence of eating disorder and depressive symptoms, their interrelationship, and their associations with metabolic control, particularly among men, regular mental health screening is recommended for young adults with type 1 diabetes.

Background: CF-related diabetes (CFRD) is a common comorbidity in cystic fibrosis (CF) and associated with negative outcome and increased mortality. In this study, we aimed to investigate current demographics of CFRD and the association of CFRD with C transmembrane conductance regulator (CFTR) genotypes.

Objectives: In recent years, CF-related diabetes (CFRD) became more prevalent and is associated with a negative effect on CF outcome.To study demographics and clinical characteristics of CFRD patients documented in the standardized, multicenter German/Austrian DPV registry.Methods: Until September 2014, data on 777 CFRD patients were included in the registry.Since 2013, the participating centers document lung function and type of CFTR mutation (n = 105) additionally to diabetes-related parameters.Descriptive statistics were carried out using SAS 9.4.c 2 -test was applied for group comparisons.Results: Patients aged on average 19.3 [IQR: 16.5-26.1]years and median age at CFRD diagnosis was 16.0 [13.4-20.6]years.Females were predominantly affected (58 vs. 42%, p < 0.019) and underweight (BMI <19 kg/m 2 ) was present in 49.2% of patients.Glycemic control assessed by HbA1c was 6.5 [5.7-7.8]%.75.4% of patients were treated with insulin or in combination with other glucose-lowering agents.Oral antidiabetic drugs only were used in 6.7% of patients and 17.9% received no glucose-lowering pharmacological therapy.The most common CF mutation 'F508del homozygote' was present in 76.2% of patients.Compared to the latest national CF benchmarking report from 2012, this mutation was more common in CFRD patients (p < 0.001). Conclusion:The study presents current data on CFRD from daily routine care.Diabetes onset is mostly around transition from pediatric care to internal medicine.Therefore, a successful and planned transition is important to provide optimal care.The previously described association between CFRD and 'F508del homozygote' is confirmed by our data.

OBJECTIVE:Several studies suggest benefits of insulin analogues detemir or glulisine in overweight and obese patients with type 2 diabetes. The present multicentre study therefore examines, whether these insulin analogues are used more frequently in patients with increased body mass index. METHODS:Data of 38 560 adult type 2 diabetic patients using insulin analogues, from 150 centres in Germany, registered in a standardized, prospective, computer-based documentation program (DPV), were included. Patients were classified into body mass index categories according to World Health Organization. Analysis was stratified by 3 time periods. To adjust for confounding effects, multivariable logistic regression models were created. RESULTS:Detemir was preferentially used in overweight (OR 1.36, 95%-CI 1.20-1.53) and obese patients (OR 2.06, 95%-CI 1.84-2.31) compared to normal-weight patients. These effects remained significant after adjusting for sex, age, new/old federal state of Germany, size of centre, treatment in university clinic and clinic/specialized private practice. Models were additionally adjusted for time period and interaction of BMI category with age or sex. For glulisine, a minor effect was present when comparing obese to normal-weight patients (OR 1.26, 95%-CI 1.06-1.50). After adjustment, this finding was no longer significant. Stratified by obesity grade, class III obese patients more frequently used detemir or glulisine compared to class I obese patients. Comparing time periods, odds ratios did not differ, neither for detemir nor for glulisine. CONCLUSION:Detemir is used more often in overweight and obese patients compared to normal-weight patients. For glulisine, the relationship is less pronounced.

BACKGROUND & AIMS:In cystic fibrosis-related diabetes (CFRD), energy needs differ from type 1 (T1D) or type 2 diabetes, and endogenous insulin secretion is not totally absent. We analyzed whether daily carbohydrate intake, its diurnal distribution and insulin requirement per 11 g of carbohydrate differ between CFRD and T1D.METHODS:Anonymized data of 223 CFRD and 36,780 T1D patients aged from 10 to <30 years from the multicenter diabetes registry DPV were studied. Carbohydrate intake and insulin requirement were analyzed using multivariable regression modeling with adjustment for age and sex. Moreover, carbohydrate intake was compared to the respective recommendations (CFRD: energy intake 130% of general population with 45% carbohydrates; T1D: carbohydrate intake 50% of total energy).RESULTS:After demographic adjustment, carbohydrate intake (238 ± 4 vs. 191 ± 1 g/d, p < 0.001) and meal-related insulin (0.52 ± 0.02 vs. 0.47 ± 0.004 IU/kg*d, p = 0.001) were higher in CFRD, whereas basal insulin (0.27 ± 0.01 vs. 0.38 ± 0.004 IU/kg*d, p < 0.001) and total insulin requirement per 11 g of carbohydrate (1.15 ± 0.06 vs. 1.70 ± 0.01 IU/d, p < 0.001) were lower compared to T1D. CFRD patients achieved 62% [Q1;Q3: 47; 77] of recommended carbohydrate intake and T1D patients 60% [51; 71] of age- and gender-specific recommended intake (p < 0.001). CFRD and T1D patients had a carbohydrate intake below healthy peers (79% [58; 100] and 62% [52; 74], p < 0.001). The circadian rhythm of insulin sensitivity persisted in CFRD and the diurnal distribution of carbohydrates was comparable between groups.CONCLUSIONS:In pediatric and young adult patients, carbohydrate intake and insulin requirement differ clearly between CFRD and T1D. However, both CFRD and T1D patients seem to restrict carbohydrates.