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Eur J Endocrinol. 2019 May 1. pii: EJE-18-0898.R2. doi: 10.1530/EJE-18-0898. [Epub ahead of print]

Diabetes care in pediatric refugees from Africa or Middle East - experiences from Germany and Austria based on real-world data from the DPV registry.

Author information

1
N Prinz, Institute of Epidemiology and Medical Biometry, ZIBMT, University Ulm, Ulm, Germany.
2
K Konrad, Department of Pediatric and Adolescent Medicine, University Children´s Hospital Cologne, Cologne, Germany.
3
C Brack, Pediatric Practice, Pediatric Practice, Celle, Germany.
4
E Hahn, Department of Pediatrics and Adolescent Medicine, Protestant Hospital Oberhausen, Oberhausen, Germany.
5
A Herbst, Department of Pediatric and Adolescent Medicine, Klinikum Leverkusen gGmbH, Leverkusen, Germany.
6
A Icks, Department of Public Health, faculty of medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
7
J Grulich-Henn, Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, University of Heidelberg, Heidelberg, Germany.
8
N Jorch, Department of Pediatrics, Evangelisches Krankenhaus Bielefeld gGmbH, Bielefeld, Germany.
9
C Kastendieck, Department of Pediatrics, Clinic Bremen-Mitte, Bremen, Germany.
10
K Mönkemöller, Children's Hospital, Hospitals of the City of Cologne, Cologne, Germany.
11
O Razum, Department of Epidemiology and International Public Health, Bielefeld University, School of Public Health, Bielefeld, Germany.
12
C Seigleder-Schweiger, Department of Pediatrics, University Hospital of Pediatrics, Paracelsus Medical University Salzburg, Salzburg, Austria.
13
M Witsch, Department of Pediatric and Adolescent Medicine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
14
R Holl, Institute of Epidemiology and Medical Biometry, ZIBMT, University Ulm, Ulm, Germany.

Abstract

OBJECTIVE:

With increasing migration to Europe, diabetes diagnosis and treatment of refugees became challenging. To describe 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 (ME vs. AFR vs. G/A: 72.3±1.0 vs. 75.0±1.4 vs. 66.0±0.1 mmol/mol, each p<0.001) and microalbuminuria (9.9 vs 13.6 vs. 6.5%, each p<0.05) was more prevalent. African children experienced severe hypoglycemia (17.8±4.3 vs. 25.4±8.7 vs. 11.5±0.3 per 100 patient years) significantly more often, whereas hypoglycemia with coma (5.1±1.1 vs. 4.1±1.6 vs. 2.6±0.1 per 100 patient years) and retinopathy (2.1 vs. n/a vs. 0.2%) 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 vs. 13.2 vs. 43.0%, each 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.

PMID:
31075760
DOI:
10.1530/EJE-18-0898

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