Psychosoziale Charakteristika von Kindern und Jugendlichen mit Typ-1-Diabetes mellitus, die zur stationären Rehabilitation eingewiesen werden – Eine bundesweite „DPV-Wiss”-Analyse

It was the goal of the trial to assess psychosocial characteristics of children and adolescents with type 1 diabetes mellitus admitted to an in-patient rehabilitation procedure German-wide. Methods: Between 01/01 and 12/31/2006 all patients younger than 20 years, admitted to a hospital of the "Arbeitsgemeinschaft (AG) Rehabilitation in der padiatrischen Diabetologie", were included in the trial. In total data of 757 children and adolescents (age 12.1 +/- 4.0 years, diabetes duration 4.6 +/- 3.6 years, HbA1c at hospital admission 7.8 +/- 1.6%) were analysed. Results: 69% of the children and adolescents admitted to an in-patient rehabilitation procedure lived in complex families with mother and father, 18% in structures with only one part (mother or father) and 3% in nursing homes or adopting families. 65% of the children and adolescents included in the trial had first-degree relatives (sisters and brothers). 91% of the patients derived out of German, 9% out of foreign or cultural mixed families. 12% of the children attending a Kindergarten, 36% were educating in general schools, 19% in higher-level schools, 15% in highest-level schools, 5% in schools for handicapped people, 7% in schools without specialisation and 1% were learning a profession. 2% reported about problems at school, sometimes with the result of non-ascending in the next higher class. The percentage of children and adolescents with problems at school was in the group aged >= 12 <20 years slightly higher than in children aged >= 6 <12 years (3% vs. 1%, p<0.05). Moreover patients in older age groups had higher HbA1c-levels too (8.3 +/- 1.7% vs 7.2 +/- 1.1%, p<0.05). Conclusions: In comparison to National statistics children and adolescents with type 1 diabetes mellitus, admitted to in-patient rehabilitation procedures, derived more frequently out of cultural mixed families and reported more often problems at school than in general population. Hence, patients admitted to in-patient rehabilitation procedures seem to be a negative selection cohort with specific diseases related problems. Also, this hypothesis is supported by higher HbA1c-levels in older age-groups and its association with patients' problems at school. Mostly, in an ambulatory setting these problems can not be treated sufficiently. The in-patient rehabilitation procedure is an important way for long-term and interdisciplinary intervention. It allows the integration of physicians, pedagogues, social workers and psychologists.