Nicole Prinz1, Christina Bächle2, Marianne Becker3, Gabriele Berger4, Angela Galler5, Holger Haberland6, Michael Meusers7, Joaquina Mirza8, Paul L Plener9, Simone von Sengbusch10, Michaela Thienelt11, Reinhard W Holl1. 1. 1 Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm , Ulm, Germany . * 2. 2 Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at Heinrich-Heine-University Düsseldorf , Düsseldorf, Germany . * 3. 3 Clinic for Children and Adolescents, Dr. Horst-Schmidt-Kliniken GmbH , Wiesbaden, Germany . 4. 4 Department of Pediatric and Adolescent Medicine, Medical University Vienna , Vienna, Austria . 5. 5 Pediatric Endocrinology and Diabetology, University Hospital for Children and Adolescents , Campus Virchow, Charité-University Hospital Berlin , Berlin, Germany . 6. 6 Hospital for Children and Adolescents, Sana Hospital Berlin Lindenhof , Berlin, Germany . 7. 7 Department of Child and Adolescent Psychiatry and Neurology, Community Hospital , Herdecke, Germany . 8. 8 Children's Hospital, Hospitals of the City of Cologne , Cologne, Germany . 9. 9 Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm , Ulm, Germany . 10. 10 Clinic for Child and Adolescent Medicine, University Hospital Schleswig-Holstein , Campus Lübeck, Lübeck, Germany . 11. 11 Clinic for Children and Adolescents, St. Vincenz Hospital , Christophorus Clinics, Coesfeld, Germany .
Abstract
BACKGROUND: The latest American Association of Clinical Endocrinologists/American College of Endocrinologists consensus statement published in 2014 does not recommend continuous subcutaneous insulin infusion (CSII) in patients with mental health problems. This study investigated the use and discontinuation of CSII in daily routine care of type 1 diabetes (T1D) patients with or without comorbid mental disorders. MATERIALS AND METHODS: Insulin-treated T1D patients (n = 48,700) between 5 and 30 years of age (median [interquartile range], 15.6 [12.0-17.7] years) from the German/Austrian diabetes patient follow-up registry (DPV) were studied. A comorbid diagnosis and/or specific treatment of mental disorder was documented in 3,158 (6.5%) patients: attention-deficit hyperactivity disorder (ADHD), n = 1,352; depression, n = 692; eating disorders, n = 395; needle phobia, n = 319; anxiety/obsessive compulsive disorder (OCD), n = 231; and psychosis and/or neuroleptic medication, n = 169. Multivariable logistic regression with age, sex, diabetes duration, and migration background as independent variables was used to compare groups. RESULTS: After adjustment for confounders, use of CSII was more common in patients with depression (41.5%), anxiety/OCD (41.4%), or needle phobia (75.8%) compared with patients without mental disorders (34.6%) (each P < 0.05). By contrast, psychotic patients (26.2%, P < 0.05) used CSII less often, and patients with ADHD (36.3%) or eating disorders (33.9%) used it with a similar frequency. Compared with patients without mental disorders (5.1%), the rate of CSII discontinuation was higher in patients with ADHD (9.7%), depression (8.2%), or eating disorders (10.0%) (P < 0.05, respectively) but similar in patients with anxiety/OCD (6.0%), psychosis (4.2%), or needle phobia (5.3%). CONCLUSIONS: In routine diabetes care, CSII use and discontinuation vary widely among T1D patients with mental disorders and indicate clear differences from the latest recommendations.
BACKGROUND: The latest American Association of Clinical Endocrinologists/American College of Endocrinologists consensus statement published in 2014 does not recommend continuous subcutaneous insulin infusion (CSII) in patients with mental health problems. This study investigated the use and discontinuation of CSII in daily routine care of type 1 diabetes (T1D) patients with or without comorbid mental disorders. MATERIALS AND METHODS:Insulin-treated T1D patients (n = 48,700) between 5 and 30 years of age (median [interquartile range], 15.6 [12.0-17.7] years) from the German/Austrian diabetespatient follow-up registry (DPV) were studied. A comorbid diagnosis and/or specific treatment of mental disorder was documented in 3,158 (6.5%) patients: attention-deficit hyperactivity disorder (ADHD), n = 1,352; depression, n = 692; eating disorders, n = 395; needle phobia, n = 319; anxiety/obsessive compulsive disorder (OCD), n = 231; and psychosis and/or neuroleptic medication, n = 169. Multivariable logistic regression with age, sex, diabetes duration, and migration background as independent variables was used to compare groups. RESULTS: After adjustment for confounders, use of CSII was more common in patients with depression (41.5%), anxiety/OCD (41.4%), or needle phobia (75.8%) compared with patients without mental disorders (34.6%) (each P < 0.05). By contrast, psychoticpatients (26.2%, P < 0.05) used CSII less often, and patients with ADHD (36.3%) or eating disorders (33.9%) used it with a similar frequency. Compared with patients without mental disorders (5.1%), the rate of CSII discontinuation was higher in patients with ADHD (9.7%), depression (8.2%), or eating disorders (10.0%) (P < 0.05, respectively) but similar in patients with anxiety/OCD (6.0%), psychosis (4.2%), or needle phobia (5.3%). CONCLUSIONS: In routine diabetes care, CSII use and discontinuation vary widely among T1D patients with mental disorders and indicate clear differences from the latest recommendations.
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