Abstract
In the treatment of children/adolescents with diabetes medical rehabilitation plays
an important role. It was the aim of the survey to analyze trends in the number of
patients admitted to rehabilitation, the quality of diabetes care, the incidence of
acute complications, risk factors for cardiovascular co-morbidities like lipids and
blood pressure and the familial status nationwide and over a period of 13 years. Methods:
Currently seven hospitals offer in-patient rehabilitation for children/adolescents
with diabetes in Germany. Six hospitals participated in the survey. All children/adolescents
(n=7.163) who participated in an in-patient rehabilitation 01/01/2004-31/12/2016 were
included. Clinical/familial data were assessed: age, sex, family situation, type/duration
of diabetes, insulin dosage, self-monitoring, acute complications, height, body weight,
blood pressure and laboratory parameters. For collecting and storage of data the computer
software DPV® (Diabetes-Patienten-Verlaufsdokumentation, University of Ulm, Germany)
was used. Statistical analyses were performed using the programme SAS (Statistical
Analysis Software 9.4, SAS Institute Inc, Cary, North Carolina, USA). Results: During
the study period 7.163 patients took part in 10.987 in-patient rehabilitation procedures.
The yearly number of patients participating in rehabilitation remained stable. There
was no change in the quality of diabetes control (HbA1c: p=0.30, fasting blood glucose:
p=0.80). The incidence of severe hypoglycaemia decreased (p<0.001). The incidence
of ketacidosis remained stable (p=0.18). The frequency of blood glucose self-monitoring
increased (p<0.001). The same was true for patients treated with CSII (p<0.001), whereas
the numbers of patients treated with CT or ICT decreased (both p<0.001). There was
no change in patients’ total insulin dose (p=0.01). There was a decrease of the number
of patients living with both parents (p<0.001), the percentage of children/adolescents
living with mother or father alone increased (p<0.001). The percentage of children/adolescents
living in mixed cultural families or having a background of immigration increased
(p<0.001). Conclusions: There is a change in medical rehabilitation: The number is
stable, the proportion of patients using CSII increased, the number of patients living
with single parents and the percentage of patients from culturally mixed families
increased also.
Key words
rehabilitation - HbA1c - education - insulin - diabetes mellitus - children
