OBJECTIVE:Adolescents with chronic health conditions (CCs) face unique developmental challenges that affect their psychological well-being. Benefit-finding and growth (BFG) may serve as a psychological resource for this population. However, longitudinal evidence on the hypothesized predictors of BFG and its impact on subjective well-being (SWB) remains scarce. This study explores the reciprocal associations between emotion-focused coping, BFG, and SWB in adolescents with CCs. METHODS:The sample included 498 adolescents (aged 12-21 years) with type 1 diabetes, juvenile idiopathic arthritis, or cystic fibrosis receiving care in Germany. Using latent cross-lagged panel models, we analyzed the directionality of the relationships between coping strategies (acceptance, cognitive reappraisal, seeking social support), BFG, and SWB (satisfaction with life, positive well-being) over 1 year. Sociodemographic and disease-related variables were controlled. RESULTS:Seeking social support at T1 was significantly associated with higher levels of BFG at T2, whereas no significant prospective associations were observed for T1 acceptance and reappraisal. An inverse cross-lagged association was found between BFG at T1 and reappraisal at T2. Furthermore, BFG at T1 was significantly associated with higher satisfaction with life at T2. CONCLUSIONS:This study provides the first longitudinal evidence of bidirectional relationships between emotion-focused coping and BFG, as well as BFG and SWB in adolescents with CCs. The findings highlight the crucial role of seeking social support in promoting BFG, which enhances adaptive emotion regulation and satisfaction with life. Future interventions should target social resources and cognitive coping strategies to improve psychological well-being in this population. CLINICAL TRIAL REGISTRATION:German Clinical Trials Register (DRKS), no. DRKS00025125. Registered on May 17, 2021.

INTRODUCTION:This study analyzed the effects of the COVID-19 pandemic and body weight on islet and endocrine autoimmunity in children with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS:Data from 11 973 children and adolescents aged 0.5 to <18 years with new-onset T1D (2015-2023) from the Diabetes Prospective Follow-up Registry were evaluated. Rates of autoantibodies against beta cells (islet antigen 2 (IA2), zinc transporter 8 (ZnT8), glutamic acid decarboxylase (GAD), insulin), thyroid, transglutaminase (TGA), and adrenals were assessed. Logistic regression models adjusted for age and sex examined associations with COVID-19 and body mass index (BMI). RESULTS:6136 (51%) children were diagnosed with T1D before, and 5837 (49%) after the beginning of the COVID-19 pandemic. Beta-cell autoantibodies were present in 94.3%, thyroid autoantibodies in 7.7%, TGA autoantibodies in 8.3%, and adrenal autoantibodies in 5.6%. During versus before COVID-19, IA2 and GAD autoantibody positivity significantly increased (63.3% vs 60.5%, p=0.002, and 65.9% vs 64.0%, p=0.04, respectively), ZnT8 autoantibodies declined (68.0% vs 71.9%, p=0.002), while insulin autoantibodies remained unchanged (p=0.06). Prevalence of IA2, ZnT8, and insulin, but not GAD autoantibodies, showed positive associations with BMI. Thyroid and TGA autoantibodies were not related, while adrenal autoantibodies were negatively related to the pandemic. CONCLUSIONS:The COVID-19 pandemic and body weight influenced autoimmunity in children with T1D. The rise in IA2 autoantibody positivity may suggest a faster progression from pre-existing autoimmunity to clinical disease. The pandemic did not appear to trigger associated endocrine autoimmunity.

Introduction: Effective bolus settings for insulin-to-carbohydrate ratios (ICRs) and insulin sensitivity factors (ISFs) are crucial for glycemic control in pediatric patients with type 1 diabetes on insulin pumps. Standard calculation methods based on the total daily insulin dose (TDD) often fall short for children. This study examined insulin pump settings for ICR and ISF in pediatric patients, considering diurnal variation, age, sex, and body mass index (BMI). The goal was to provide data-driven recommendations for initial bolus settings. Methods: We analyzed insulin pump settings in 7697 pediatric patients with type 1 diabetes in the DPV registry (Diabetes Prospective Follow-up) from Germany, Austria, Switzerland, and Luxembourg. Patients aged 1 to <18 years, postremission (diabetes duration >1 year, insulin dose ≥0.5 IU/kg/d), with good metabolic control (HbA1c ≤7.5%), using insulin pumps with short-acting analog insulin in 2023, were included. Automated insulin delivery system users were excluded. Patients were grouped by age (<6, 6 to <12, 12 to <18 years), BMI percentiles (P75), and sex. Results: Older children required more insulin, with lower ICRs and ISFs. Insulin requirements peaked in the morning with the lowest ICR and ISF, with medians (interquartile ranges): <6 years: 11.2 g carbs/IU (9.1-14.0) and 1:150 mg/dL (70-228); 6 to <12 years: 8.7 g carbs/IU (7.0-10.7) and 1:90 (50-140); and 12 to <18 years: 6.1 g carbs/IU (5.0-7.7) and 1:50 (40-80). ISF was highest in the late evening in all age groups, while a higher BMI-SDS was associated with a lower ISF. Girls above 6 years had lower ICR but similar ISF to that of boys. The factor obtained by multiplying ISF and TDD was comparable in all age groups and BMI categories. Conclusion: Our real-world findings on CSII settings in a large cohort of children with sufficient metabolic control highlight the inadequacy of a single TDD-based calculation formula, as insulin requirements varied by age, time of day, sex, and BMI. These findings may serve as a reference for commonly used age-dependent parameters for clinicians in establishing initial CSII settings before individualized dose titration and optimization.

Objectives: The aim of this study is to examine the association between diabetic ketoacidosis (DKA) at type 1 diabetes diagnosis and long-term glycemic outcomes, insulin requirements, BMI SDS and diabetes technology uptake in youth. Research design and methods: Data from nine countries (Austria, Czechia, Germany, Italy, Luxembourg, New Zealand, Slovenia, Switzerland and USA (Colorado)) including youth (0.5-15.9 years) diagnosed with type 1 diabetes in 2019-2020 and followed for 2 years thereafter. Participants were divided into three groups: no DKA, non-severe, and severe DKA at diagnosis. HbA1c, insulin requirements, BMI SDS, and use of technology, including automated insulin delivery (AID), were assessed. Results: A total of 9,269 individuals (54.8% males, mean age 9.0 years) were included in the analysis. DKA at diagnosis was observed in 34.2% of participants and severe DKA in 12.8%. After one year, adjusted mean HbA1c was higher in the severe DKA group (7.41%) compared to non-severe DKA (7.23%, p=0.001) and no DKA groups (7.14, p<0.001), and this difference persisted after two years (7.58% vs. 7.38%, p<0.001, and vs 7.32%, p<0.001). Higher BMI SDS was observed in both DKA groups compared to no DKA. The use of AID was associated with lower HbA1c levels compared to other treatment modalities and moderated differences between DKA groups after two years of follow up (p=0.072). Conclusions: Both severe and non-severe DKA at type 1 diabetes diagnosis were associated with persistently higher HbA1c and higher BMI SDS. AID use diminishes the association of DKA at diagnosis and higher HbA1c over time.

Introduction and Objective: Treatment choices and outcomes for children with T1D vary by country, but the influence of economic wealth is not well studied. Aim: To evaluate this association using SWEET registry data Methods: A cross-sectional analysis of 54,285 individuals with T1D under 25 years, diagnosed for > 3 months, from 130 SWEET centers (2022-2023). Subjects were stratified by country GDP in four groups. Key variables included HbA1c, BMI, insulin dose, use of CGM, insulin pumps, and AID. Height and BMI z-scores followed WHO references. Regression models adjusted for age, diabetes duration, and sex. Results: Height z-scores were lowest in the low GDP group (-0.44) versus +0.24 to +0.50 in higher GDP groups. BMI z-scores increased from +0.04 in the low GDP group to +0.89 in the high GDP group (p < 0.001). Insulin requirements were highest in the low GDP group (0.93 U/kg) versus 0.75-0.79 U/kg in other groups (p < 0.001). CGM use rose from 36% in the low GDP group to 91% in the high GDP group, insulin pump use from 17% to 70%, and AID systems from 11% to 38% (all p < 0.001). HbA1c was highest in the low GDP group (8.7%) and lowest in the lower-middle group (7.5%), followed by 7.7% (upper-middle) and 8.1% (high GDP). DKA was most frequent in the high GDP group, while severe hypoglycemia was most common in the low GDP group (both p < 0.001). Conclusion: A strong association exists between GDP and nutritional status, technology use, and metabolic outcomes in pediatric T1D. Best metabolic control was in countries with lower-middle or upper-middle income. High-GDP countries showed poorer control, higher BMI, and more frequent DKA. These findings stress the need for better resource allocation in pediatric diabetes care. C. Martinez Mateu: Other Relationship; Sanofi-Aventis Argentina. S.S. Gupta: None. R. Duperval: None. R.A. Thabet: None. D. Al-Abdulrazzaq: None. M. Pogajepec: None. O. Kaminska-Jackowiak: None. M.M. Cavalin: None. S. Munoz: None. C. Sanon: None. S. Sap: None. R.W. Holl: None. D. Pacaud: Research Support; Medtronic, Novo Nordisk, Eli Lilly and Company.

The incidence of type 1 diabetes (T1D) in children increased significantly during the COVID-19 pandemic (1,2). However, it is not known whether this increase is a persistent phenomenon, which would have significant implications for future patient care. The aim of this study was to investigate the long-term incidence of childhood T1D in Germany during the nine years before and four years after the emergence of COVID-19.

Introduction and Objective: Following the successful implementation of the Stuttgart Diabetic Ketoacidosis (DKA) Prevention Campaign at local level, we have extended this proven concept to the Federal State of Baden-Wuerttemberg (BW) in Germany. Methods: All public health departments (PHD) in BW were invited over 3 years to hand out flyers and posters about the typical symptoms of diabetes to parents and caregivers as part of the school entry examination and to provide information about the disease. 14 of 38 PHD (37%) participated in the intervention. During the campaign 55370 information flyers and 2556 posters were distributed. Additional awareness activities were performed by the different PHDs. A comparative analysis of the DKA-incidence at diabetes onset was conducted in participating and non-participating districts, prior (2015-2020) and during the campaign (2021-2023). Results: 3038 children and adolescents were newly diagnosed with type 1 diabetes in BW during the observation period. DKA was present in 990 children (32,6%), severe DKA in 346 (11.4%). DKA rates among children and adolescents increased both in participating districts (29.9 % to 36.3 %) as well as in non-participating districts (27.0 % to 41.0 %; p<0.0001 for time-trend). However, there was a significant interaction between time-interval and the groups of districts (p<0.03) reflecting a significant treatment effect in the intervention group. Conclusion: The expansion of our local Awareness Campaign was possible and successful. The combination of a personal approach and cross-sectoral, interdisciplinary cooperation is an essential factor for the feasibility of prevention campaigns. And awareness campaigns need ongoing efforts to provide continued preventive effects. M. Holder: Speaker's Bureau; Medtronic, Sanofi-Aventis Deutschland GmbH. J. Weiler: None. R.W. Holl: None. S. Ehehalt: None.

Prädiktion und Prävention des Typ-1-Diabetes bilden den Rahmen für die Diskussion, ob ein Antikörperscreening Teil der Regelversorgung werden sollte. Der Inselautoantikörpertest charakterisiert nicht die Stoffwechselsituation, sondern ist eine Momentaufnahme von Autoimmunität und ermöglicht eine Prognose des künftigen Typ-1-Diabetes-Risikos. Für Personen mit positivem Test bietet er jedoch keine verlässliche, individuelle Vorhersage, wann die Erkrankung auftreten wird. Eine medikamentöse Therapie zur Prävention des Typ-1-Diabetes ist aktuell noch nicht verfügbar. Somit konfrontiert ein positiver Test Betroffene mit einer Krankheitsprognose, ohne dass ein sinnvolles Therapieangebot existiert. Die psychologische Belastung des Tests kann daher erheblich sein. Weitere klinische Studien sind erforderlich, um Nutzen und Risiken des Inselautoantikörpertests zu untersuchen.

Background: Devices for continuous glucose monitoring (CGM) have been developed to optimize blood glucose control and liberate people with diabetes from finger-prick glucose measurements. Since 2016, the devices have been reimbursed in Germany for people with diabetes receiving insulin therapy, resulting in their increased use among people with type 1 diabetes (T1D) and type 2 diabetes (T2D). We investigated the prevalence of CGM use and its associated factors among German adults with diabetes in 2017 and 2021/2022. Methods: Participants aged 18 years or older with diagnosed diabetes were identified from two nationwide population-based telephone surveys in 2017 (n = 1396) and 2021/2022 (n = 1456). Prevalence and dynamics of CGM use were examined overall and stratified by sociodemographic and diabetes-related characteristics. Factors associated with CGM use were obtained from logistic regression models. Results: The overall prevalence of CGM use was 8.2% in 2017 and 16.6% in 2021/2022. An increase in CGM use was observed across all the subgroups except for those without antidiabetic medications. CGM use increased from 31.1% to 75.4% in adults with T1D, from 6.3% to 13.6% in adults with T2D, and from 14.6% to 36.7% in all insulin users. In both surveys, younger age, insulin use, T1D, and reporting hypoglycemia were associated with CGM use. In addition, in 2017, higher education level and absence of obesity were associated with CGM use, whereas in 2021/2022, participation in the diabetes self-management education program and higher self-assessed quality of diabetes care were associated with CGM use. Conclusion: Among adults with diabetes in Germany, CGM use increased about twofold within 5 years, irrespective of sociodemographic factors. Educational inequality in CGM use diminished over time. The higher self-rated quality of diabetes care associated with the recent use of CGM provides further evidence to support its use among all adults with diabetes in Germany.

AIMS:The Real-world Evidence for Decisions in Diabetes (REDDIE) project aims to better understand how to use real-world data (RWD) to advance research related to diabetes. To achieve this aim, four national registries (National Diabetes Audit (NDA (England)), Diabetes Patienten Verlaufsdokumentation (DPV (Germany)), Swedish National Registries (NDR), Danish National Registries (DNR)) are contributing data to the REDDIE project. This publication aims to describe the four registries and compare their unique strengths and limitations. METHODS:Data regarding the four registries were extracted from their inception until 2024. Data regarding demographics, prescriptions, outcomes, lifestyle and diabetes-specific variables (usage of continuous glucose monitors) were summarised. RESULTS:A core set of variables was identified across all four registries in the REDDIE project. Demographic information, diabetes-related medication, measures of glycaemic control and lifestyle factors are measured in all four registries. The DNR, NDA and NDR also contain wider prescription data, diagnosis data (cardiovascular disease, retinopathy) and mortality data. The DPV registry does not contain these data but contains detailed data on continuous glucose monitor and insulin pump usage. Differences in the methodologies employed and data fields collected were identified, including in data collection techniques, linkage processes, follow-up protocols and the range of variables recorded. Even with this diversity in data collection, there remains a significant opportunity to perform collaborative analysis between the registries. By combining RWD collected in different populations and health care systems with diverse demographics, the transferability of evidence will increase, enabling research studies to be more representative and inclusive of diverse populations. CONCLUSION:The four registries that make up the REDDIE project contain many commonly collected variables. However, each registry presents specific strengths and limitations. By including all four databases, the REDDIE project benefits from the complementary strengths of each database.

Objective: To expand the effective local Stuttgart childhood diabetic ketoacidosis (DKA) prevention campaign to the federal state of Baden-Württemberg (BW) in Germany. Research Design and Methods: All public health departments (PHDs) in BW were invited to participate. The DKA-incidence at diabetes onset was compared between participating and nonparticipating districts, prior (2015-2020) and during the campaign (2021-2023). Results: A total of 3038 children and adolescents were newly diagnosed with type 1 diabetes in BW during the observation period. DKA was present in 990 children (32.6%), severe DKA in 346 (11.4%). In total 14 of 38 PHD (37%) participated. DKA rates increased both in participating (29.9%-36.3%) and in nonparticipating districts (27.0%-41.0%; p < 0.0001 for time-trend). However, there was a significant interaction between time-interval and the groups of districts (p < 0.03) reflecting a significant treatment effect in the intervention group. Conclusions: The expansion of our local awareness campaign was possible and successful.

Um die Qualität von ambulanter Adipositastherapie für Kinder und Jugendliche zu sichern, ist die Überprüfung von Behandlungsstandards durch eine Zertifizierung wesentlich. Für Behandlungszentren ist diese mit Aufwand (z. B. Beschaffung und Aufbereitung von Daten) verbunden. Vor dem Hintergrund des Rückgangs zertifizierter Zentren in Deutschland (2015: 54 vs. 2022: 29) resultiert das Ziel, explorativ die Hintergründe zu erfassen, um Optimierungsempfehlungen abzuleiten. Im Jahr 2022 wurde im zuständigen Fachverband (Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter (AGA) der Deutschen Adipositas-Gesellschaft) eine explorative Querschnittserhebung unter den 431 Mitgliedern durchgeführt. Der digitale Fragebogen beinhaltete standardisierte offene und geschlossene Fragen zur Zertifizierung sowie persönliche Angaben. Die explorativen Daten von 80 Fragebögen wurden deskriptiv ausgewertet. Gründe für die Ablehnung einer Zertifizierung waren die Kosten und Personalaufwand, die Bereitstellung von qualifiziertem Personal, formale Anforderungen und Abläufe der Zertifizierung und die Notwendigkeit der Generierung eines wirtschaftlichen Mehrwertes durch eine Zertifizierung, wie die Anerkennung der Einrichtung als zertifiziertes Zentrum durch die Kostenträger. Die Ergebnisse deuten zwei Optimierungsempfehlungen an: 1.) verbindliche Regelungen zur Therapiekostenübernahme für zertifizierte Zentren durch Kostenträger, 2.) Reduktion des personellen Aufwandes für die Zertifizierung, die z. B. durch eine Reduktion formaler Anforderungen sowie Digitalisierung möglich erscheint. Künftige Studien sollten die explorativen Ergebnisse validieren.

Introduction and Objective: Guidelines recommend GLP-1 receptor agonists (GLP-1-RA) and SGLT2 inhibitors (SGLT2i) for individuals with type 2 diabetes (T2D) at high risk of atherosclerotic cardiovascular disease (ASCVD). We aimed to develop a personalized treatment algorithm to guide the initial decision between these therapies. Methods: Using data from the Diabetes Prospective Follow-up registry (Germany/Austria) we studied individuals with T2D who initiated GLP-1-RA (n=823) or SGLT2i (n=1,566) in a multicenter, real-world setting. Dual users were excluded. Baseline characteristics included age, sex, BMI, eGFR, HbA1c, diabetes duration, and history of ASCVD. Non-fatal ASCVD events (MI, angina, revascularization, stroke, TIA, PAD) were analyzed using dynamic weighted survival modeling to predict the optimal treatment for each individual. Results: Based on a linear decision rule (Figure), the algorithm predicted 48% of individuals to have better ASCVD outcomes with GLP-1-RA and 52% with SGLT2i. GLP-1-RA-optimal individuals had on average a higher BMI (37 vs 31 kg/m²), lower eGFR (71 vs 93 ml/min per 1.73 m2) and less history of ASCVD (9 vs 18%) compared to SGLT2i-optimal individuals. Conclusion: Simple clinical features (BMI, eGFR, history of ASCVD) can guide personalized treatment recommendations to prevent non-fatal ASCVD complications in T2D. T. Mori: None. O. Kuss: None. J.K. Mader: Advisory Panel; Abbott. Speaker's Bureau; Abbott. Advisory Panel; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company. Stock/Shareholder; elyte Diagnostics. Advisory Panel; embecta. Speaker's Bureau; embecta, Menarini. Advisory Panel; Medtronic. Speaker's Bureau; Dexcom, Inc. Advisory Panel; Dexcom, Inc., Novo Nordisk A/S. Speaker's Bureau; Novo Nordisk A/S. Advisory Panel; Roche Diabetes Care. Speaker's Bureau; Roche Diabetes Care. Advisory Panel; Sanofi. Speaker's Bureau; Sanofi. Advisory Panel; Biomea Fusion, PharmaSens, Tingo Medical. Stock/Shareholder; decide Clinical Software. J. Seufert: Speaker's Bureau; Sanofi-Aventis Deutschland GmbH. Advisory Panel; Boehringer-Ingelheim. Speaker's Bureau; Boehringer-Ingelheim. Research Support; Boehringer-Ingelheim. Advisory Panel; Lilly Diabetes. Speaker's Bureau; Lilly Diabetes. Research Support; Lilly Diabetes. Advisory Panel; Novo Nordisk. Speaker's Bureau; Novo Nordisk. Research Support; Novo Nordisk. R.W. Holl: None. S. Lanzinger: None. J.M. Grimsmann: None.

Smoking is a risk factor for cardiovascular complications and can promote a severe course of COVID-19 infection. The aim of this study was to compare smoking habits of young people with diabetes with the general population. We analyzed smoking behavior in the Diabetes Prospective Follow-up Registry (DPV) cohort (type 1 (T1D) and type 2 diabetes (T2D) from Germany and T1D from Austria aged 14–24 years) and compared it to data from the German survey on smoking behavior (DEBRA study) of the general population. Data were aggregated per year and patient for 2016–2023. Logistic regression models adjusted for gender and migration background were calculated stratified by age groups (14–17; 18–24 years), taking repeated measurements into account. Smoking behavior between T1D and T2D or between Germany and Austria was compared with similar regression models. Thirty-four thousand two hundred seventy-five patients from the DPV cohort were included in data analysis. The overall proportion of people who smoked was lower in DPV than in the general population (13.4