1
|
Achenbach P, Berner R, Bonifacio E, Brämswig S, Braig S, Dunstheimer D, Ermer U, Ewald D, Gemulla G, Hauer J, Haupt F, Haus G, Hubmann M, Hummel S, Kandler M, Kordonouri O, Lange K, Laub O, Lorrmann A, Nellen-Hellmuth N, Sindichakis M, von dem Berge T, Warncke K, Weber L, Winkler C, Wintermeyer P, Ziegler AG. Früherkennung von Typ-1-Diabetes durch Inselautoantikörper-Screening – ein Positionspapier der Fr1daPlex-Projektleiter und -Schulungszentren, des BVKJ Bayern und PaedNetz Bayern e.V. Gesundheitswesen 2024. [PMID: 38710228 DOI: 10.1055/a-2320-2859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Dieses Positionspapier basiert auf der langjährigen klinischen Erfahrung und grundlagen-wissenschaftlichen Forschung der Autoren zur Diagnose und Behandlung von Kindern und Jugendlichen mit einem präsymptomatischen Frühstadium des Typ-1-Diabetes. Der Nutzen sowie potenzielle Nachteile der Früherkennung von Typ-1-Diabetes durch ein Inselautoantikörper-Screening werden kritisch diskutiert. Zudem werden die Perspektiven einer Verzögerung des Ausbruchs der klinischen Stoffwechselerkrankung durch eine Teplizumab-Behandlung adressiert. Wir sehen heute die Chance einer relevanten Verbesserung der therapeutischen Möglichkeiten und der Lebensperspektive betroffener Kinder und Jugendlicher. Wichtige nächste Schritte für die Implementierung eines Inselautoantikörper-Screenings in Deutschland sind die Fortbildung der Kinder- und Jugendärzte, die über das Screening aufklären sollen, die Etablierung von wenigen überregionalen Laboratorien, die die Testung durchführen, und die Ausweitung regionaler Kapazitäten für Schulung und Betreuung der Kinder mit einem Frühstadium des Typ-1-Diabetes.
This position paper is based on the authors' many years of clinical experience and basic science research on the diagnosis and treatment of children and adolescents with a presymptomatic early stage of type 1 diabetes. The benefits as well as potential disadvantages of early detection of type 1 diabetes by islet autoantibody screening are critically discussed. In addition, the perspectives of delaying the onset of the clinical metabolic disease through treatment with teplizumab are addressed. Today, we see the chance of a relevant improvement in the therapeutic options and life perspectives of affected children and adolescents. Important next steps for the implementation of islet autoantibody screening in Germany are the training of pediatricians who should inform families about the screening, the establishment of a few transregional laboratories that carry out the test, and the expansion of regional capacities for the training and care of children with an early stage of type 1 diabetes.
Collapse
Affiliation(s)
- Peter Achenbach
- Institut für Diabetesforschung, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | - Reinhard Berner
- Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Kinder- und Jugendmedizin, Technische Universität Dresden, Dresden, Germany
| | - Ezio Bonifacio
- Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany
| | - Susanne Brämswig
- Klinik für Kinder- und Jugendmedizin, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Sonja Braig
- Klinik für Kinder und Jugendliche, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Desiree Dunstheimer
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Uwe Ermer
- Kinder- und Jugendmedizin, Ameos Klinikum St. Elisabeth Neuburg, Neuburg an der Donau, Germany
| | - Dominik Ewald
- Bahnhofstr. 24, Kinderarztpraxis, Regensburg, Germany
| | - Gita Gemulla
- Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Kinder- und Jugendmedizin, Technische Universität Dresden, Dresden, Germany
- Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany
| | - Julia Hauer
- Zentrum für Kinder und Jugendmedizin, München Klinik und Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | - Florian Haupt
- Institut für Diabetesforschung, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | - Gabi Haus
- Hans-Mielich-Str. 35, Kinderarztpraxis, München, Germany
| | | | - Sandra Hummel
- Institut für Diabetesforschung, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | | | - Olga Kordonouri
- Diabetologie, Endokrinologie und Allgemeine Pädiatrie, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Karin Lange
- Medizinische Psychologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Otto Laub
- Happinger Str. 98, Kinderarztpraxis, Rosenheim, Germany
| | - Anja Lorrmann
- Kinder und Jugendmedizin, KJF Klinik Josefinum GmbH, Augsburg, Germany
| | | | - Marina Sindichakis
- Klinik für Kinder- und Jugendmedizin, Kinderdiabetologie, Klinikum Traunstein, Traunstein, Germany
| | - Thekla von dem Berge
- Diabetologie, Endokrinologie und Allgemeine Pädiatrie, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Katharina Warncke
- Zentrum für Kinder und Jugendmedizin, München Klinik und Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | - Leonie Weber
- Klinik für Kinderheilkunde und Jugendmedizin, Kinderdiabetologie, Klinikum Kempten-Oberallgau GmbH, Kempten, Germany
| | - Christiane Winkler
- Institut für Diabetesforschung, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | | | - Anette-Gabriele Ziegler
- Institute fro Diabetes Research, Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| |
Collapse
|
2
|
Hummel S, Carl J, Friedl N, Winkler C, Kick K, Stock J, Reinmüller F, Ramminger C, Schmidt J, Lwowsky D, Braig S, Dunstheimer D, Ermer U, Gerstl EM, Weber L, Nellen-Hellmuth N, Brämswig S, Sindichakis M, Tretter S, Lorrmann A, Bonifacio E, Ziegler AG, Achenbach P. Children diagnosed with presymptomatic type 1 diabetes through public health screening have milder diabetes at clinical manifestation. Diabetologia 2023; 66:1633-1642. [PMID: 37329450 PMCID: PMC10390633 DOI: 10.1007/s00125-023-05953-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/25/2023] [Indexed: 06/19/2023]
Abstract
AIMS/HYPOTHESIS We aimed to determine whether disease severity was reduced at onset of clinical (stage 3) type 1 diabetes in children previously diagnosed with presymptomatic type 1 diabetes in a population-based screening programme for islet autoantibodies. METHODS Clinical data obtained at diagnosis of stage 3 type 1 diabetes were evaluated in 128 children previously diagnosed with presymptomatic early-stage type 1 diabetes between 2015 and 2022 in the Fr1da study and compared with data from 736 children diagnosed with incident type 1 diabetes between 2009 and 2018 at a similar age in the DiMelli study without prior screening. RESULTS At the diagnosis of stage 3 type 1 diabetes, children with a prior early-stage diagnosis had lower median HbA1c (51 mmol/mol vs 91 mmol/mol [6.8% vs 10.5%], p<0.001), lower median fasting glucose (5.3 mmol/l vs 7.2 mmol/l, p<0.05) and higher median fasting C-peptide (0.21 nmol/l vs 0.10 nmol/l, p<0.001) compared with children without previous early-stage diagnosis. Fewer participants with prior early-stage diagnosis had ketonuria (22.2% vs 78.4%, p<0.001) or required insulin treatment (72.3% vs 98.1%, p<0.05) and only 2.5% presented with diabetic ketoacidosis at diagnosis of stage 3 type 1 diabetes. Outcomes in children with a prior early-stage diagnosis were not associated with a family history of type 1 diabetes or diagnosis during the COVID-19 pandemic. A milder clinical presentation was observed in children who participated in education and monitoring after early-stage diagnosis. CONCLUSIONS/INTERPRETATION Diagnosis of presymptomatic type 1 diabetes in children followed by education and monitoring improved clinical presentation at the onset of stage 3 type 1 diabetes.
Collapse
Affiliation(s)
- Sandra Hummel
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany.
- German Center for Diabetes Research (DZD), Munich, Germany.
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, Munich, Germany.
- Forschergruppe Diabetes at Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany.
| | - Johanna Carl
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
| | - Nadine Friedl
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
| | - Christiane Winkler
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, Munich, Germany
| | - Kerstin Kick
- Forschergruppe Diabetes at Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Joanna Stock
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
| | - Franziska Reinmüller
- Forschergruppe Diabetes at Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Claudia Ramminger
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
| | - Jennifer Schmidt
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, Munich, Germany
| | | | - Sonja Braig
- Pediatric Clinic of the Bayreuth Hospital, Bayreuth, Germany
| | | | - Uwe Ermer
- St Elisabeth Klinik, Neuburg an der Donau, Germany
| | | | | | | | | | | | | | | | - Ezio Bonifacio
- German Center for Diabetes Research (DZD), Munich, Germany
- Center for Regenerative Therapies Dresden, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Paul Langerhans Institute Dresden of the Helmholtz Centre Munich at the University Clinic Carl Gustav Carus of TU Dresden and Faculty of Medicine, Dresden, Germany
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, Munich, Germany
- Forschergruppe Diabetes at Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Peter Achenbach
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany.
- German Center for Diabetes Research (DZD), Munich, Germany.
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, Munich, Germany.
- Forschergruppe Diabetes at Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany.
| |
Collapse
|
3
|
Biester T, Grimsmann JM, Heidtmann B, Rami-Merhar B, Ermer U, Wolf J, Freff M, Karges B, Agena D, Bramlage P, Danne T, Holl RW. Intermittently Scanned Glucose Values for Continuous Monitoring: Cross-Sectional Analysis of Glycemic Control and Hypoglycemia in 1809 Children and Adolescents with Type 1 Diabetes. Diabetes Technol Ther 2021; 23:160-167. [PMID: 33084351 DOI: 10.1089/dia.2020.0373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background and Objective: Intermittent scanning continuous glucose monitoring (iscCGM) is increasingly used for glycemic monitoring in diabetes care. In this cross-sectional real-world analysis, iscCGM data were compared to traditional parameters of glycemic control in young people with type 1 diabetes. Methods: Using the DPV registry, most recent data from children and adolescents aged <18 years with uploaded iscCGM sensor profiles with at least 14 days of data and a > 50% completeness were evaluated using recommended parameters of sensor metrics. Analysis was performed stratified by age group, glycemic control, and type of therapy; data were taken from DPV data pool in February 2020. Results: Glucose sensor profiles and clinical data from 1809 individuals (mean age 13.4 years, 53% male, and mean diabetes duration 5.02 years) were evaluated in this study. More than 50% of this population (n = 965) reached the current German treatment target of hemoglobin A1c (HbA1c) <7.5%. In this target, the mean scanning frequency was higher than in groups with HbA1c >7.5 or >8.0% (12.0 vs. 10.2 vs 7.6 times per day). The group of preschool children had the highest frequency of scanning (16.6 vs. 13.3 times per day in school kids and 7.9 in adolescents), the lowest HbA1c level, and the lowest risk for hypoglycemia (low blood glucose index 0.8 vs. 1.0 vs 1.2). Conclusion: Real-world data will help to determine the value of iscCGM to improve clinical and patient-related outcomes in pediatric diabetology. Not only the use of a device but also the intensity of use seems to have a high and direct impact on glycemic control.
Collapse
Affiliation(s)
- Torben Biester
- Kinder-und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Julia M Grimsmann
- Institut für Epidemiologie und Medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | | | - Birgit Rami-Merhar
- Medical University of Vienna, Austria, Department od Pediatric and Adolescent Medicine, Vienna, Austria
| | - Uwe Ermer
- Kliniken St. Elisabeth, Klinik für Kinder-und Jugendmedizin, Neuburg, Germany
| | - Johannes Wolf
- Klinik für Kinder-und Jugendmedizin St. Louise, St. Vincenz-Krankenhaus, Paderborn, Germany
| | - Markus Freff
- Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt, Germany
| | - Beate Karges
- Bethlehem Gesundheitszentrum, Klinik für Kinder-und Jugendmedizin, Stolberg, Germany
- Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
| | - Dirk Agena
- Kinderärztliche Gemeinschaftspraxis Franziska Fritz und Dirk Agena, Hildesheim, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Thomas Danne
- Kinder-und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Reinhard W Holl
- Institut für Epidemiologie und Medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| |
Collapse
|
4
|
Grimsmann JM, von Sengbusch S, Freff M, Ermer U, Placzek K, Danne T, Hammer E, Holl RW. Glucose Management Indicator Based on Sensor Data and Laboratory HbA 1c in People With Type 1 Diabetes From the DPV Database: Differences by Sensor Type. Diabetes Care 2020; 43:e111-e112. [PMID: 32690487 DOI: 10.2337/dc20-0259] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/04/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Julia M Grimsmann
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany .,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | | | - Markus Freff
- Princess Margaret Children's Clinic, Darmstadt, Germany
| | - Uwe Ermer
- Kliniken St. Elisabeth, Neuburg/Donau, Germany
| | - Kerstin Placzek
- University Hospital Halle (Saale), Martin-Luther University, Halle, Germany
| | - Thomas Danne
- Children's and Youth Hospital Auf der Bult, Hannover, Germany
| | - Elke Hammer
- Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | | | | |
Collapse
|
5
|
Heinrich M, Maison N, Achenbach P, Assfalg R, Braig S, Böcker D, Dunstheimer D, Ermer U, Gavazzeni A, Gerstl EM, Hummel S, Kick K, Müller H, Nellen-Hellmuth N, Ockert C, Sindichakis M, Tretter S, Warncke K, Ziegler AG, Beyerlein A. Fasting hypoglycemia is associated with disease progression in presymptomatic early stage type 1 diabetes. Pediatr Diabetes 2018; 19:1238-1242. [PMID: 30098103 DOI: 10.1111/pedi.12739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/22/2018] [Accepted: 07/02/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE In children with presymptomatic type 1 diabetes, intermittent hyperglycemia and rising hemoglobin A1c levels are a known signal of progression toward insulin-dependency. Episodes of hypoglycemia, however, have also been reported in one published case. We investigated the prevalence of hypoglycemia and its association with disease progression in children with presymptomatic type 1 diabetes. METHODS We compared the frequency of hypoglycemic fasting blood glucose levels (<60 mg/dL) in 48 autoantibody negative and 167 multiple β-cell autoantibody positive children aged 2 to 5 years. We classified the autoantibody positive children into three categories based on their glucose levels in fasting state (hypoglycemic [<60 mg/dL], normoglycemic [60-99 mg/dL] or hyperglycemic [≥100 mg/dL]). We then compared the glucose levels under challenge during oral glucose tolerance tests (OGTTs) between the three categories. RESULTS In the autoantibody positive children, 5.1% of the fasting samples were hypoglycemic, while in the autoantibody negative children no hypoglycemia was observed. Hypoglycemia occurred more often in autoantibody positive children who had already entered stage 2 or stage 3 of type 1 diabetes than in stage 1 patients (P = 0.02). Children who had hypoglycemic compared to normoglycemic fasting blood glucose values had higher 120-minute blood glucose values under OGTT challenge, and a higher rate of pathological OGTTs (P = 0.04). CONCLUSIONS Fasting hypoglycemia seems to be an indicator of disease progression in presymptomatic type 1 diabetes and may therefore represent a novel marker for the identification of children who should be monitored more closely for progression toward insulin-dependent type 1 diabetes.
Collapse
Affiliation(s)
- Melanie Heinrich
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Nicole Maison
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Peter Achenbach
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Robin Assfalg
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Sonja Braig
- Department of Pediatrics, Klinikum Bayreuth, Bayreuth, Germany
| | - Dominik Böcker
- Department of Pediatrics, Klinikum Nürnberg Nord, Nuremberg, Germany
| | | | - Uwe Ermer
- Department of Pediatrics, Kliniken St Elisabeth, Neuburg an der Donau, Germany
| | | | - Eva-Maria Gerstl
- Department of Pediatric Diabetology, Pediatric Hospital Dritter Orden Passau, Passau, Germany
| | - Sandra Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Kerstin Kick
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Herbert Müller
- Department of Pediatrics, Klinikum Kempten, Kempten, Germany
| | | | | | | | - Stefanie Tretter
- Department of Pediatrics, Kliniken Nordoberpfalz, Weiden, Germany
| | - Katharina Warncke
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany.,Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Anette-Gabriele Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | | |
Collapse
|
6
|
Kick K, Assfalg R, Aydin S, Bechtold-Dalla Pozza S, Böcker D, Braig S, Bunk M, Dunstheimer D, Durmashkina A, Ermer U, Gavazzeni A, Gerstl EM, Heinrich M, Herbst M, Kriesen Y, Kuhnle-Krahl U, Müller H, Nellen-Hellmuth N, Ockert C, Ramminger C, Sindichakis M, Tretter S, Warncke K, Achenbach P, Ziegler AG, Hoffmann VS. Recruiting young pre-symptomatic children for a clinical trial in type 1 diabetes: Insights from the Fr1da insulin intervention study. Contemp Clin Trials Commun 2018; 11:170-173. [PMID: 30197933 PMCID: PMC6126533 DOI: 10.1016/j.conctc.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 11/15/2022] Open
Abstract
Background Although detection of children at high risk of developing type 1 diabetes and diagnosis of early stages is possible, up to now there exists no approved therapy to delay or prevent type 1 diabetes. Thus it is vital to develop evidence-based interventions. For this a sufficient number of trial participants is crucial but difficult to obtain especially in asymptomatic children. Aim Identifying family characteristics that lead to or impede trial participation and analyze reasons stated by families for non-participation. Methods Participants for the Fr1da Insulin Intervention study are recruited from the Fr1da study, a population based screening for early stage type 1 diabetes in Bavaria. Families with eligible children were invited to enroll. We analyzed sex and age of the child, distance of the family to the study center in Munich and the existence of a first degree family member with type 1 as possible influential factors for study participation. We also analyzed reasons stated by families who declined study participation in a phone interview. Results Of 146 eligible children 77 (53%) were enrolled into the trial. None of the tested family characteristics differed significantly between the enrolling and the families not participating, but in general enrolling families lived closer to the study site than families not participating. This is also reflected in the reasons given by non-participating families. The most frequent reason stated were time restrictions. The second most frequent reason was the venous blood draw. Conclusion The factors for non-participation identified in this project need be taken into account for the design of future trials in young children to ensure proper recruitment and thus to generate valid results for medical treatment of children. More research on the reason of participation and non-participation in clinical trials is needed.
Collapse
Affiliation(s)
- Kerstin Kick
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
| | - Robin Assfalg
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | - Susanne Aydin
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
| | | | | | | | - Melanie Bunk
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | | | - Alevtina Durmashkina
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
| | - Uwe Ermer
- Kliniken St. Elisabeth, Neuburg/Donau, Germany
| | | | | | - Melanie Heinrich
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
| | - Melanie Herbst
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | - Yvonne Kriesen
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | | | | | | | | | - Claudia Ramminger
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | | | | | - Katharina Warncke
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Department of Pediatrics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Peter Achenbach
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | - Anette-G. Ziegler
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Corresponding author. Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg , Germany.
| | - Verena S. Hoffmann
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Corresponding author. Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg , Germany.
| |
Collapse
|
7
|
Lange K, Achenbach P, Assfalg R, Bassy M, Bechthold-Dalla Pozza S, Böcker D, Braig S, Dietz B, Dunstheimer D, Eber S, Ermer U, Gavazzeni A, Gerstl EM, Götz M, Haupt F, Haus G, Heinrich M, Heublein A, Huhn F, Jolink M, Kick K, Knopff A, Koch C, Koch R, Kuhnle-Krahl U, Kriesen Y, Landendörfer W, Lang M, Laub O, Leipold G, Leppik KH, Müller H, Nellen-Hellmuth N, Ockert C, Raminger C, Renner C, Schulzik L, Sindichakis M, Tretter S, Warncke K, Winkler C, Zeller S, Ziegler AG, Müller I. Screening auf positive diabetes-spezifische Antikörper bei Kindern in Bayern (Fr1da-Projekt): psychische Folgen der Diagnose „früher Typ-1-Diabetes“ für Eltern. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- K Lange
- Medizinische Hochschule Hannover, Medizinische Psychologie, Hannover, Germany
| | - P Achenbach
- Institut für Diabetesforschung, Helmholtz Zentrum München, München, Germany
| | - R Assfalg
- Institut für Diabetesforschung, Helmholtz Zentrum München, München, Germany
| | - M Bassy
- Medizinische Hochschule Hannover, Medizinische Psychologie, Hannover, Germany
| | | | - D Böcker
- Klinikum Nürnberg, Nürnberg, Germany
| | - S Braig
- Klinikum Bayreuth, Bayreuth, Germany
| | - B Dietz
- Berufsverband der Kinder- und Jugendärzte e.V. Bayern, München, Germany
| | | | - S Eber
- Berufsverband der Kinder- und Jugendärzte e.V. Bayern, München, Germany
| | - U Ermer
- Kliniken St. Elisabeth, Neuburg/Donau, Germany
| | - A Gavazzeni
- Kinderarztpraxis Bogenhausen, München, Germany
| | - EM Gerstl
- Klinikum Dritter Orden, Passau, Germany
| | - M Götz
- Berufsverband der Kinder- und Jugendärzte e.V. Bayern, Elisabethszell, Germany
| | - F Haupt
- Institut für Diabetesforschung, Helmholtz Zentrum München, München, Germany
| | - G Haus
- PaedNetz Bayern e.V., München, Germany
| | - M Heinrich
- Institut für Diabetesforschung, Helmholtz Zentrum München, München, Germany
| | - A Heublein
- Institut für Diabetesforschung, Helmholtz Zentrum München, München, Germany
| | - F Huhn
- Medizinische Hochschule Hannover, Medizinische Psychologie, Hannover, Germany
| | - M Jolink
- Institut für Diabetesforschung, Helmholtz Zentrum München, München, Germany
| | - K Kick
- Institut für Diabetesforschung, Helmholtz Zentrum München, München, Germany
| | - A Knopff
- Institut für Diabetesforschung, Helmholtz Zentrum München, München, Germany
| | - C Koch
- Institut für Diabetesforschung, Helmholtz Zentrum München, München, Germany
| | - R Koch
- Leopoldina Hospital, Schweinfurt, Germany
| | | | - Y Kriesen
- Institut für Diabetesforschung, Helmholtz Zentrum München, München, Germany
| | - W Landendörfer
- Berufsverband der Kinder- und Jugendärzte e.V. Bayern, Nürnberg, Germany
| | - M Lang
- Berufsverband der Kinder- und Jugendärzte e.V. Bayern, Augsburg, Germany
| | - O Laub
- Berufsverband der Kinder- und Jugendärzte e.V. Bayern, Rosenheim, Germany
| | - G Leipold
- Berufsverband der Kinder- und Jugendärzte e.V. Bayern, Regensburg, Germany
| | - KH Leppik
- Berufsverband der Kinder- und Jugendärzte e.V. Bayern, Erlangen, Germany
| | - H Müller
- Klinikum Kempten, Kempten, Germany
| | | | - C Ockert
- RoMed Klinikum, Rosenheim, Germany
| | - C Raminger
- Institut für Diabetesforschung, Helmholtz Zentrum München, München, Germany
| | - C Renner
- Praxis Kinder- und Jugendmedizin, Deggendorf, Germany
| | - L Schulzik
- Institut für Diabetesforschung, Helmholtz Zentrum München, München, Germany
| | | | | | - K Warncke
- Abteilung Pädiatrie, Klinikum rechts der Isar, München, Germany
| | - C Winkler
- Institut für Diabetesforschung, Helmholtz Zentrum München, München, Germany
| | - S Zeller
- Berufsverband der Kinder- und Jugendärzte e.V. Bayern, Kempten, Germany
| | - AG Ziegler
- Institut für Diabetesforschung, Helmholtz Zentrum München, München, Germany
| | - I Müller
- Medizinische Hochschule Hannover, Medizinische Psychologie, Hannover, Germany
| |
Collapse
|
8
|
Biester T, Hermann J, Heidtmann B, Rami-Merhar B, Ermer U, Wolf J, Freff M, Karges B, Agena D, Danne T, Holl R. Intermittierend gescannte Glukoseprofile (FGM) bei Kindern und Jugendlichen mit Typ-1-Diabetes: Korrelation mit traditioneller Bewertung der Stoffwechseleinstellung (HbA1c-Wert) – eine multizentrische DPV-Analyse. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- T Biester
- Kinder- und Jugendkrankenhaus 'Auf der Bult', Hannover, Germany
| | - J Hermann
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
| | - B Heidtmann
- Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Germany
| | - B Rami-Merhar
- Medizinische Universität Wien, Universitätsklinik für Kinder- und Jugendheilkunde, Wien, Austria
| | - U Ermer
- Kliniken St. Elisabeth, Klinik für Kinder- und Jugendmedizin, Neuburg, Germany
| | - J Wolf
- St. Louise-Krankenhaus, Klinik für Kinder- und Jugendmedizin, Paderborn, Germany
| | - M Freff
- Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt, Germany
| | - B Karges
- Bethlehem Gesundheitszentrum, Klinik für Kinder- und Jugenmedizin, Stolberg, Germany
| | - D Agena
- Kinderärztliche Gemeinschaftspraxis Dr. med. Heinz-A. Mogalle und Dirk Agena, Hildesheim, Germany
| | - T Danne
- Kinder- und Jugendkrankenhaus 'Auf der Bult', Hannover, Germany
| | - R Holl
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
| |
Collapse
|
9
|
Kick K, Assfalg R, Bechtold-Dalla Pozza S, Böcker D, Braig S, Dunstheimer D, Engelsberger I, Ermer U, Gavazzeni A, Gerstl EM, Haupt F, Knopff A, Koch R, Kuhnle-Krahl U, Lang M, Laub O, Maison N, Müller H, Nellen-Hellmuth N, Ockert C, Renner C, Schmidt SC, Sindichakis M, Tretter S, Winkler C, Warncke K, Achenbach P, Ziegler AG. Fr1da study at half time: screening for early stage type 1 diabetes in more than 50000 children aged from 2 to 5 years. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- K Kick
- Institute of Diabetes Research, Helmholtz-Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - R Assfalg
- Institute of Diabetes Research, Helmholtz-Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | | | - D Böcker
- Klinikum Nürnberg, Nürnberg, Germany
| | - S Braig
- Klinikum Bayreuth, Bayreuth, Germany
| | | | - I Engelsberger
- Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - U Ermer
- Kliniken St. Elisabeth, Neuburg/Donau, Germany
| | - A Gavazzeni
- Kinderarzt Praxis Bogenhausen, München, Germany
| | - EM Gerstl
- Klinikum Dritter Orden, Passau, Germany
| | - F Haupt
- Institute of Diabetes Research, Helmholtz-Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - A Knopff
- Institute of Diabetes Research, Helmholtz-Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - R Koch
- Leopoldina Hospital, Schweinfurt, Germany
| | | | - M Lang
- Berufsverband der Kinder- und Jugendärzte e.V., Landesverband Bayern, Augsburg, Germany
| | - O Laub
- PaedNetz Bayern e.V., Rosenheim, Germany
| | - N Maison
- Institute of Diabetes Research, Helmholtz-Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - H Müller
- Klinikum Kempten, Kempten, Germany
| | | | - C Ockert
- RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - C Renner
- Praxis für Kinder- und Jugendmedizin, Deggendorf, Germany
| | | | | | | | - C Winkler
- Institute of Diabetes Research, Helmholtz-Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - K Warncke
- Institute of Diabetes Research, Helmholtz-Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - P Achenbach
- Institute of Diabetes Research, Helmholtz-Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - AG Ziegler
- Institute of Diabetes Research, Helmholtz-Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, München, Germany
| |
Collapse
|
10
|
Heinrich M, Bechtold-Dalla Pozza S, Böcker D, Braig S, Dunstheimer D, Engelsberger I, Ermer U, Gavazzeni A, Gerstl EM, Koch R, Kuhnle-Krahl U, Müller H, Nellen-Hellmuth N, Ockert C, Renner C, Schmidt SC, Sindichakis M, Tretter S, Warncke K, Achenbach P, Ziegler AG. Blutzuckerwerte bei Kindern mit präsymptomatischem Typ-1-Diabetes: Erfahrungsberichte aus der Fr1da Studie. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M Heinrich
- Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - S Bechtold-Dalla Pozza
- Klinikum der Ludwig-Maximilians-Universität München, Dr. von Haunersches Kinderspital, München, Germany
| | - D Böcker
- Klinikum Nürnberg, Nürnberg, Germany
| | - S Braig
- Klinikum Bayreuth, Bayreuth, Germany
| | | | - I Engelsberger
- Kinderklinik Schwabing, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - U Ermer
- Kliniken St. Elisabeth, Neuburg/Donau, Germany
| | - A Gavazzeni
- Kinderarztpraxis Bogenhausen, München, Germany
| | - EM Gerstl
- Klinikum Dritter Orden, Passau, Germany
| | - R Koch
- Leopoldina Hospital, Schweinfurt, Germany
| | | | - H Müller
- Klinikum Kempten, Kempten, Germany
| | | | - C Ockert
- RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - C Renner
- Praxis für Kinder- und Jugendmedizin, Deggendorf, Germany
| | - SC Schmidt
- Klinikum Dritter Orden, München, Germany
| | | | | | - K Warncke
- Kinderklinik Schwabing, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - P Achenbach
- Helmholtz Zentrum München, Institut für Diabetesforschung, München, Germany
| | - AG Ziegler
- Klinikum rechts der Isar, Technische Universität München, München, Germany
| |
Collapse
|
11
|
Sydlik C, Ermer U, Odenwald B, Schmidt H. Neugeborenes mit intersexuellem Genitale bei unauffälligem Neugeborenenscreening. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-016-0150-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
12
|
Renner E, Rylaarsdam S, Anover S, Hartl D, Jayakumar A, Belohradsky B, Ermer U, Jin Y, Kleiner G, Nagel F, Zhu Q, Claymann G, Torgerson T, Ochs H. Comèl-Netherton Syndrome - New Insight Into The Molecular Basis of this Rare Syndrome Characterized by Atopic Diathesis and Immune Deficiency. J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.11.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
13
|
Renner E, Rylaarsdam S, Anover S, Belohradsky B, Ermer U, Hackett M, Hornung R, Jin Y, Nagel F, Kleiner G, Stiehm R, Lu HM, Zhu Q, Torgerson T, Ochs H. Impaired Humoral Immune Response to a T-Cell-Dependent Neoantigen in Patients with ComèL-Netherton Syndrome. Clin Immunol 2006. [DOI: 10.1016/j.clim.2006.04.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|