P-314: Thirty years of metabolic outcomes and therapeutic progress in pediatric type 1 diabetes: evidence from the multinational DPV registry
S Lanzinger, N Wilms, B Karges, T Biester, C Boettcher, K Warncke, C Reinauer, C Kamrath, S Hofer, B Rami-Merhar, U Schierloh, A EckertAbstract
Introduction
The diabetes prospective follow-up registry (DPV) was established in 1995 and enables to show changes in diabetes care and associated outcomes over the last 30 years.
Objectives
We examined time trends in metabolic outcomes, acute complications and diabetes technology use among children and adolescents with type 1 diabetes (T1D) from Germany, Switzerland, Austria, and Luxembourg.
Methods
Data from 107,641 individuals aged <18 years with T1D and a diabetes duration greater than three months were included (1995 to 2025). Regression models assessed trends in HbA1c, event rates of severe hypoglycemia (SH) and diabetic ketoacidosis (DKA), continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM) and automated insulin delivery (AID). Age was categorized as <6, 6-<12, and 12-<18 years.
Results
Mean HbA1c decreased from 8.1% (95%-CI: 8.1-8.2) in 1995 to 7.1% (7.1-7.2) in 2025, and the proportion achieving an HbA1c <7% increased (25.9% (24.5-27.3) to 51.7% (51.2-52.3)). Event rates of SH decreased (18.8 (15.9-22.2) to 5.8 (5.4-6.2) events per 100 person-years (PY)) and rates of DKA remained stable over the years (2.1 (1.6-2.8) per 100 PY in 1995) with a significant decline starting from 2023 onwards to 1.3 (1.1-1.4) events per 100 PY. CSII use increased from 3.5% (3.2-3.8) in 2000 to 81.1% (80.7-81.6), and reached 94.5% (93.6-95.4) among children <6 years of age in 2025. CGM use evolved from 24.8% (24.2-25.3) in 2016 to 97.6% (97.4-97.7) in 2025. As of 2020 AID use increased from 5.2% (4.9-5.4) to 69.3% (68.8-69.9), with the highest usage in the youngest age group (82.0% (80.5-83.4)).
Conclusions
Over the past 30 years, significant improvements in metabolic control and a reduction in acute complications have been achieved, with the increased use of diabetes technology, and AID especially, being a main contributor. These results aim for equal accessibility to diabetes technology for all age groups.