Demographic characteristics and acute complications among adults with type 1 diabetes: Comparison of two multicentre databases from Germany and the United States

• Published in: Journal of diabetes and its complications Vol. 35; no. 3; p. 107812
• Main Authors: Eckert, Alexander J., Zhou, Fang L., Grimsmann, Julia M., Pettus, Jeremy H., Kerner, Wolfgang, Miller, Kellee M., Stechemesser, Lars, Edelman, Steven V., Spies, Carsten, Holl, Reinhard W., Ibald-Mulli, Angela M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2021; Elsevier Limited
• Subjects: Adolescent; Adult; Adults; Age; Blood pressure; Cholesterol; Creatinine; Databases, Factual; Demographics; Demography; Diabetes; Diabetes Complications - epidemiology; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - epidemiology; Diabetic ketoacidosis; Diabetic Ketoacidosis - epidemiology; Emergency medical care; Epidemiology; Female; Germany - epidemiology; Glycated Hemoglobin A - analysis; Humans; Hypertension; Hypoglycemia; Hypoglycemia - epidemiology; Insulin; Laboratories; Male; Metabolic control; Metabolism; Patients; Registries; Statistical analysis; Type 1 diabetes; United States - epidemiology; Young adults; United States; Germany; United States > US; Austria; Adults; Hypoglycemia; Type 1 diabetes; Metabolic control; Diabetic ketoacidosis
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2020.107812

Studies on acute complications in adult T1D were previously reported from the United States (U.S.) and from Germany. The aim was to compare demographic characteristics and patterns of severe hypoglycaemia (SH) and diabetic ketoacidosis (DKA) between Germany and the U.S.
Descriptive comparison on individuals aged ≥18 years, with T1D duration ≥2 years were made between the German diabetes-patient registry (DPV) and the U.S. electronic-health-record database (T1PCO). Individuals in both databases were divided into patients with haemoglobin A1c (HbA1c) <7% and HbA1c ≥7%.
5190 (DPV) and 31,430 individuals (T1PCO) fulfilled the inclusion criteria. DPV patients were younger, more often male and had lower body-mass index. In both databases, more males than females had HbA1c <7%. Individuals had higher HbA1c in T1PCO compared to DPV. The relationship between HbA1c and DKA was similar in both databases. SH revealed a U-shaped curve in T1PCO, but no clear pattern was present in DPV. SH events increased with higher age in DPV, but not in T1PCO.
Patterns of SH differ between Germany and U.S. Differences in capture of SH among the databases cannot be excluded, but differences in health care including patient education and level of care by specialists are likely.
•HbA1c- and age-related patterns of SH differ between Germany and U.S.•Possibly, due to differences in capture of SH.•Metabolic control (especially in young adults) is worse in T1PCO compared to DPV.•Patient education and level of care by specialists may play a role.