Area deprivation and demographic factors associated with diabetes technology use in adults with type 1 diabetes in Germany

Frontiers in Endocrinology

Endocrinology

Peter M. Jehle¹  Anton Gillessen²  Martin Heni³  Lars Schwettmann⁴  Sebastian M. Meyhöfer⁵  Alexander J. Eckert⁶  Marie Auzanneau⁶  Reinhard W. Holl⁶  Michael Hummel⁷ 

[1] Department of Internal Medicine I, University Medicine, Academic Hospital Paul-Gerhardt-Stift, Martin-Luther-University Halle-Wittenberg, Lutherstadt Wittenberg, Germany;Department of Internal Medicine, Sacred Heart Hospital, Muenster, Germany;Division of Endocrinology and Diabetology, Department of Internal Medicine 1, University Hospital Ulm, Ulm, Germany;Department for Diagnostic Laboratory Medicine, Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, Tübingen, Germany;Division of Health Economics, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany;German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany;Institute for Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany;Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany;German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany;Research Group Diabetes e.V., Helmholtz Center Munich, Munich-Neuherberg, Germany;

关键词: Type 1 diabetes;    adults;    diabetes technology;    CGM;    pump;    age;    gender;    deprivation;   

DOI  :  10.3389/fendo.2023.1191138

 received in 2023-03-21, accepted in 2023-06-30,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionDiabetes technology improves glycemic control and quality of life for many people with type 1 diabetes (T1D). However, inequalities in access to diabetes technology exist in many countries. In Germany, disparities in technology use have been described in pediatric T1D, but no data for adults are available so far. We therefore aimed to analyze whether demographic factors and area deprivation are associated with technology use in a representative population of adults with T1D.Materials and methodsIn adults with T1D from the German prospective diabetes follow-up registry (DPV), we analyzed the use of continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), and sensor augmented pump therapy (SAP, with and without automated insulin delivery) in 2019-2021 by age group, gender, migration background, and area deprivation using multiple adjusted regression models. Area deprivation, defined as a relative lack of area-based resources, was measured by quintiles of the German index of Multiple Deprivation (GIMD 2015, from Q1, least deprived, to Q5, most deprived districts).ResultsAmong 13,351 adults with T1D, the use of technology decreased significantly with older age: CSII use fell from 56.1% in the 18−<25-year age group to 3.1% in the ≥80-year age group, CGM use from 75.3% to 28.2%, and SAP use from 45.1% to 1.5% (all p for trend <0.001). The use of technology was also significantly higher in women than in men (CSII: 39.2% vs. 27.6%; CGM: 61.9% vs. 58.0%; SAP: 28.7% vs. 19.6%, all p <0.001), and in individuals without migration background than in those with migration background (CSII: 38.8% vs. 27.6%; CGM: 71.1% vs. 61.4%; SAP: 30.5% vs. 21.3%, all p <0.001). Associations with area deprivation were not linear: the use of each technology decreased only from Q2 to Q4.DiscussionOur real-world data provide evidence that higher age, male gender, and migration background are currently associated with lower use of diabetes technology in adults with T1D in Germany. Associations with area deprivation are more complex, probably due to correlations with other factors, like the higher proportion of migrants in less deprived areas or the federal structure of the German health care system.

【 授权许可】

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Copyright © 2023 Auzanneau, Eckert, Meyhöfer, Heni, Gillessen, Schwettmann, Jehle, Hummel and Holl