Completed projects

Association between area-level deprivation and diabetes care and clinical out-comes in children and adolescents with type 1 diabetes from Germany (DZD Grant 2017)
Heads:Dr. Joachim Rosenbauer, Düsseldorf (PI); Dr. Werner Maier, Neuherberg (Co-PI); Prof. Dr. Reinhard Holl, Ulm (Co-PI)
Duration:01/01/2017 – 31/12/2017
Summary:The overall quality of care in children and adolescents with type 1 diabetes (T1D) from Germany seems to be good. However, a previous study showed substantial regional differences in diabetes treatment and metabolic control between German federal states. Studies already indicated an inverse association between individual socio-economic status (SES) and treatment and metabolic control. Aside differences in individual SES, access to health care providers, medical reimbursement decisions, and area-level deprivation might have contributed to regional differences. Recently, the German Index of Multiple Deprivation (GIMD) was developed and validated in several studies showing the impact of area-level deprivation on different health-related outcomes. To date, no study has been conducted to investigate the association between area-level deprivation and paediatric diabetes care and outcomes in detail in Germany.
Aims:The aims of the project are to analyse
1) the regional distribution of T1D treatment and outcomes at municipality- and district-level,
2) the association between area-level deprivation (municipality- and district-level GIMD) and diabetes treatment (insulin regimen, frequency of self-monitoring of blood-glucose use of continuous glucose monitoring systems, use of insulin analogues, diabetes education) and,
3) the association between area-level deprivation (municipality- and district-level GIMD) and indicators of glycaemic control (HbA1c), acute diabetic complications (severe hypoglycaemia, diabetic ketoacidosis, hospitalization), and the prevalence of overweight in children and adolescents with T1D < 20 years from Germany.
Methods:The Institute for Biometrics and Epidemiology at the German Diabetes Centre in Düsseldorf will contribute their excellent expertise in advanced statistical data analysis taking into account spatial heterogeneity and interpretation of data and skills in geographic information systems and geographical mapping.
The Institute of Health Economics and Health Care Management at Helmholtz Zentrum München will provide GIMD data at municipality and district level. Project members of the institute will contribute expertise on the use of deprivation indices, geographic information systems, geographical mapping and multilevel modelling.
The Institute of Epidemiology and Medical Biometry at Ulm University will provide the clinical data. Data will be extracted from the DPV registry, cleansed and aggregated, and subsequently linked to GIMD scores at district and municipality level based on postal codes of residence. The Ulm group will further add expertise in epidemiological regression modelling and will be responsible for a comprehensive literature search and preparation of joint publications.