[Challenges in the Analysis of Health Care Inequalities in Pediatric Rehabilitation]. / Herausforderungen in der Analyse von Versorgungsungleichheiten in der Kinderrehabilitation.

BACKGROUND: Social inequalities on access and utilization of inpatient rehabilitation among adolescents have rarely been studied. METHODS: Parents of children with chronic health conditions (age of 7-17) were interviewed about access and utilization of inpatient rehabilitation. Parents were recruited through pediatricians as well as rehabilitation centers in Central Germany. RESULTS: Despite of numerous recruitment measures the participation by pediatricians was low. Also expanding the sample did not remedial. Furthermore, fewer adolescents with need of rehabilitation were achieved than expected. The analysis is subject to these restrictions, nevertheless, they still allow explorative statements about access and utilization of pediatric rehabilitation. CONCLUSION: Despite major challenges in recruitment, pediatricians should be considered into analysis of inequalities in rehabilitation because of their gatekeeper function.

Type 2 diabetes from pediatric to geriatric age: analysis of gender and obesity among 120,183 patients from the German/Austrian DPV database.

AIM: To characterize the clinical phenotype of type 2 diabetes mellitus (T2DM) with respect to age, gender, and BMI. METHOD: Anonymized data of 120,183 people with T2DM from the German/Austrian multicenter Diabetes Patienten Verlaufsdokumentation database were analyzed based on chronological age or age at diagnosis (0-19, 20-39, 40-59, 60-79, and ≥80 years). Age, gender, and BMI comparisons with clinical phenotype were made using χ(2) and Kruskal-Wallis tests (SAS V9.2). RESULTS: Of all the patients, 51.3% were male, average age was 67.112.7 years, and average disease duration was 9.99.1 years. More girls than boys were diagnosed during adolescence and more men than women during adulthood (2060 years). No gender differences existed when age at diagnosis was 60 years. Patients were obese on average (BMI: 30.5±6.1 kg/m(2)) and had significantly higher BMI values than German population peers. The BMI gap was widest in the younger age categories and closed with increasing age. Adult women were significantly more obese than men. Obese patients more often had elevated HbA1c (≥7.5%), hypertension or dyslipidemia (irrespective of age), microalbuminuria (adults), or retinopathy (elderly) than nonobese patients. More men than women (20-60 years) had hypertension, dyslipidemia, or microalbuminuria while more women than men (≥60 years) had hypertension or dyslipidemia. CONCLUSION: During puberty, more girls than boys were diagnosed with T2DM while during adulthood males predominated. T2DM manifested at comparatively lower BMI in males, and younger patients were more obese at diagnosis. Age, gender, and BMI were also associated with poor metabolic control and cardiovascular disease comorbidities/complications.

Multiple complications and frequent severe hypoglycaemia in 'elderly' and 'old' patients with Type 1 diabetes.

AIM: Elderly and old patients with Type 1 diabetes represent a growing population that requires thorough diabetes care. The increasing relevance of this subgroup, however, plays only a minor role in the literature. Here, we describe elderly patients with Type 1 diabetes on the basis of a large multi-centre database in order to point out special features of this population. METHOD: Data of 64609 patients with Type 1 diabetes treated by 350 qualified diabetes treatment centres were assessed and analysed by age group. RESULTS: Compared with the age group ≤ 60 years, patients aged >60 years (n=3610 61-80 years and n=377 >80 years old) were characterized by a longer diabetes duration (27.7 vs. 7.7 years), an almost double risk for severe hypoglycaemia (40.1 vs. 24.3/100 patient-years), a lower level of HbA(1c) [60 vs. 67 mmol/mol (7.6 vs. 8.3%)] and higher percentages of microalbuminuria (34.5 vs. 15.6%), diabetic retinopathy (45.2 vs. 8.3%), myocardial infarction (9.0 vs. 0.4%) or stroke (6.8 vs. 0.3%). Elderly patients used insulin pumps less frequently (12.2 vs. 23.8%), but more often used conventional premixed insulin treatment (10.8 vs. 3.8%). Differences between elderly and younger patient groups were significant, respectively. CONCLUSION: Diabetes care of elderly patients with Type 1 diabetes involves individualized treatment concepts. Increased hypoglycaemia risk and functional impairment attributable to diabetes-associated and/or age-related disorders must be taken into account.