Reinhard W. Holl’s research while affiliated with Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e.V. and other places

Introduction and Objective: Following the successful implementation of the Stuttgart Diabetic Ketoacidosis (DKA) Prevention Campaign at local level, we have extended this proven concept to the Federal State of Baden-Wuerttemberg (BW) in Germany. Methods: All public health departments (PHD) in BW were invited over 3 years to hand out flyers and posters about the typical symptoms of diabetes to parents and caregivers as part of the school entry examination and to provide information about the disease. 14 of 38 PHD (37%) participated in the intervention. During the campaign 55370 information flyers and 2556 posters were distributed. Additional awareness activities were performed by the different PHDs. A comparative analysis of the DKA-incidence at diabetes onset was conducted in participating and non-participating districts, prior (2015-2020) and during the campaign (2021-2023). Results: 3038 children and adolescents were newly diagnosed with type 1 diabetes in BW during the observation period. DKA was present in 990 children (32,6%), severe DKA in 346 (11.4%). DKA rates among children and adolescents increased both in participating districts (29.9 % to 36.3 %) as well as in non-participating districts (27.0 % to 41.0 %; p<0.0001 for time-trend). However, there was a significant interaction between time-interval and the groups of districts (p<0.03) reflecting a significant treatment effect in the intervention group. Conclusion: The expansion of our local Awareness Campaign was possible and successful. The combination of a personal approach and cross-sectoral, interdisciplinary cooperation is an essential factor for the feasibility of prevention campaigns. And awareness campaigns need ongoing efforts to provide continued preventive effects. Disclosure M. Holder: Speaker's Bureau; Medtronic, Sanofi-Aventis Deutschland GmbH. J. Weiler: None. R.W. Holl: None. S. Ehehalt: None.

Introduction and Objective: The transition process from pediatric to adult type 1 diabetes (T1D) care is poorly explored. We aimed to assess transition for youth living with T1D worldwide. Methods: SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) database was analyzed (2016-2023, centers >20 patients, > 5-year data). Transfer was assumed in T1D patients 14-24 years with no visits for ≥2 years. Age at transfer was evaluated across regions. A survey developed by pediatric and adult diabetologists was distributed to all SWEET centers. Results: Among 33,418 transferred patients (104 centers, 51% male), age at T1D transfer was 18.7 years in Asia/Middle East/Africa, 18.4 in North America/Canada, 18.0 in Europe, 17.2 in Australia/New Zealand and 17.0 in South America (p <0.0001). Female gender and higher HbA1c were associated with earlier transfer (- 0.1 year, p <0.0002; - 0.08, p <0.0001), longer duration and larger centers with later transfer (p <0.0001). Of 160 surveyed centers, 79 responded: 43 in Europe, 20 Asia/Middle East/Africa, 8 North America, 6 South America, 2 Australia/New Zealand, 87% academic, 74% exclusively pediatric, 57% with age limit for pediatric care reimbursement. Annually, 80% of centers transferred <50 patients; 13% of centers transferred at 20+ years, 41% at 18-20, 27% at 16-18 and 9% at 14-16 years (no transfer: 6%). Structured transition was absent in 34% of centers. Key drivers for transfer included age (83% of centers), reimbursement policies (8%) and patient request (4%). Metabolic control (60%), psychiatric comorbidity (63%) and teen pregnancy (59%) influenced transfer, while technology use and T1D complications did not. Conclusion: This study highlights the global variability in T1D transition and the lack of structured transition in many centers. More efforts are needed to enhance transition preparation and a successful transfer for youth with T1D. Disclosure B. Piccini: Advisory Panel; Sanofi. R.W. Holl: None. F. Malik: None. C. de Beaufort: None. N.S. Elbarbary: None. V. Iotova: Other Relationship; Pfizer Inc, Novo Nordisk, AstraZeneca, Rezolute Bio, Medtronic, Novartis Pharmaceuticals Corporation, Novo Nordisk. C. Kanaka-Gantenbein: Research Support; Abbott, Amgen Inc. Advisory Panel; Kyowa Kirin Co., Ltd. Research Support; Novo Nordisk. Advisory Panel; Pfizer Inc, Sanofi. H. Kim: None. J.M. Leung: None. J. Mirza: None. L. Preechasuk: None. S. Toni: Consultant; Abbott. Advisory Panel; Sanofi.

Zusammenfassung Um die Qualität von ambulanter Adipositastherapie für Kinder und Jugendliche zu sichern, ist die Überprüfung von Behandlungsstandards durch eine Zertifizierung wesentlich. Für Behandlungszentren ist diese mit Aufwand (z. B. Beschaffung und Aufbereitung von Daten) verbunden. Vor dem Hintergrund des Rückgangs zertifizierter Zentren in Deutschland (2015: 54 vs. 2022: 29) resultiert das Ziel, explorativ die Hintergründe zu erfassen, um Optimierungsempfehlungen abzuleiten. Im Jahr 2022 wurde im zuständigen Fachverband (Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter (AGA) der Deutschen Adipositas-Gesellschaft) eine explorative Querschnittserhebung unter den 431 Mitgliedern durchgeführt. Der digitale Fragebogen beinhaltete standardisierte offene und geschlossene Fragen zur Zertifizierung sowie persönliche Angaben. Die explorativen Daten von 80 Fragebögen wurden deskriptiv ausgewertet. Gründe für die Ablehnung einer Zertifizierung waren die Kosten und Personalaufwand, die Bereitstellung von qualifiziertem Personal, formale Anforderungen und Abläufe der Zertifizierung und die Notwendigkeit der Generierung eines wirtschaftlichen Mehrwertes durch eine Zertifizierung, wie die Anerkennung der Einrichtung als zertifiziertes Zentrum durch die Kostenträger. Die Ergebnisse deuten zwei Optimierungsempfehlungen an: 1.) verbindliche Regelungen zur Therapiekostenübernahme für zertifizierte Zentren durch Kostenträger, 2.) Reduktion des personellen Aufwandes für die Zertifizierung, die z. B. durch eine Reduktion formaler Anforderungen sowie Digitalisierung möglich erscheint. Künftige Studien sollten die explorativen Ergebnisse validieren.

Introduction and Objective: Guidelines recommend GLP-1 receptor agonists (GLP-1-RA) and SGLT2 inhibitors (SGLT2i) for individuals with type 2 diabetes (T2D) at high risk of atherosclerotic cardiovascular disease (ASCVD). We aimed to develop a personalized treatment algorithm to guide the initial decision between these therapies. Methods: Using data from the Diabetes Prospective Follow-up registry (Germany/Austria) we studied individuals with T2D who initiated GLP-1-RA (n=823) or SGLT2i (n=1,566) in a multicenter, real-world setting. Dual users were excluded. Baseline characteristics included age, sex, BMI, eGFR, HbA1c, diabetes duration, and history of ASCVD. Non-fatal ASCVD events (MI, angina, revascularization, stroke, TIA, PAD) were analyzed using dynamic weighted survival modeling to predict the optimal treatment for each individual. Results: Based on a linear decision rule (Figure), the algorithm predicted 48% of individuals to have better ASCVD outcomes with GLP-1-RA and 52% with SGLT2i. GLP-1-RA-optimal individuals had on average a higher BMI (37 vs 31 kg/m²), lower eGFR (71 vs 93 ml/min per 1.73 m2) and less history of ASCVD (9 vs 18%) compared to SGLT2i-optimal individuals. Conclusion: Simple clinical features (BMI, eGFR, history of ASCVD) can guide personalized treatment recommendations to prevent non-fatal ASCVD complications in T2D. Disclosure T. Mori: None. O. Kuss: None. J.K. Mader: Advisory Panel; Abbott. Speaker's Bureau; Abbott. Advisory Panel; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company. Stock/Shareholder; elyte Diagnostics. Advisory Panel; embecta. Speaker's Bureau; embecta, Menarini. Advisory Panel; Medtronic. Speaker's Bureau; Dexcom, Inc. Advisory Panel; Dexcom, Inc., Novo Nordisk A/S. Speaker's Bureau; Novo Nordisk A/S. Advisory Panel; Roche Diabetes Care. Speaker's Bureau; Roche Diabetes Care. Advisory Panel; Sanofi. Speaker's Bureau; Sanofi. Advisory Panel; Biomea Fusion, PharmaSens, Tingo Medical. Stock/Shareholder; decide Clinical Software. J. Seufert: Speaker's Bureau; Sanofi-Aventis Deutschland GmbH. Advisory Panel; Boehringer-Ingelheim. Speaker's Bureau; Boehringer-Ingelheim. Research Support; Boehringer-Ingelheim. Advisory Panel; Lilly Diabetes. Speaker's Bureau; Lilly Diabetes. Research Support; Lilly Diabetes. Advisory Panel; Novo Nordisk. Speaker's Bureau; Novo Nordisk. Research Support; Novo Nordisk. R.W. Holl: None. S. Lanzinger: None. J.M. Grimsmann: None.