Eur J Pediatr (2005) 164: 705–707

DOI 10.1007/s00431-005-1709-9

SHO RT REPOR T

Edith Schober Æ Reinhard W. Holl Æ Matthias Grabert

Angelika Thon Æ Birgit Rami Æ Thomas Kapellen
Ora Seewi Æ Thomas Reinehr

Diabetes mellitus type 2 in childhood and adolescence in Germany

and parts of Austria
Received: 27 January 2005 / Accepted: 1 May 2005 / Published online: 13 July 2005
Ó Springer-Verlag 2005

existing diabetes patients in this age group in Ger-

Introduction many.
A rise in the prevalence of type 2 diabetes mellitus
(T2 DM) in adolescence and childhood has been ob-
served in North America, especially in minority pop- Method
ulations such as the American Indians, during the past
decades [2]. Few epidemiological data on the incidence Data [gender, date of birth, date of diabetes mani-
of the disease in young people exist in Europe [1, 4, 5]. festation, weight, height, body mass index (BMI),
To obtain an estimate of the magnitude of this prob- insulin requirements and HbA1c] from 25,706 diabetic
lem in Germany, we tried to evaluate the prevalence of patients longitudinally documented in 179 diabetic
T2 DM in people under the age of 20 years using the centres in Germany and parts of Austria in a stan-
DPV-Wiss database, a database covering half of the dardized quality control database were included in the
analysis. Since 1991, participants have been asked to
characterize their patients according to the diagnostic
criteria of the American Diabetes Association (ADA)
as either type 1 diabetes mellitus (T1 DM), T2 DM,
This article was written on behalf of the DPV-Wiss Initiative of the type 3 diabetes [other specific types of diabetes, such
German Working Group for Pediatric Diabetology as cystic fibrosis-related diabetes mellitus (CFRDM)],
E. Schober (&) Æ B. Rami
or gestational diabetes. Diagnosis of T2 DM was
University Children’s Hospital, based on clinical case definition, using overweight at
Waehringer Guertel 18–20, diagnosis, a positive family history of T2 DM, evi-
1090 Vienna, Austria dence of insulin resistance and lack of ketonuria at
E-mail: edith.schober@meduniwien.ac.at onset as indications for assignment.
Tel.: +43-1-404003232
Fax: +43-1-404003238
R. W. Holl Æ M. Grabert
ZIBMT and Department of Paediatrics, Results
University of Ulm, Ulm, Germany
A. Thon Fewer than 1% (n=227) were diagnosed as having
University Children’s Hospital, T2 DM. Those patients were significantly older at
Hanover, Germany
manifestation and more often female than type 1 dia-
T. Kapellen betic patients were (Table 1).
University of Leipzig, Type 2 diabetic patients showed a higher prevalence
Hospital for Children and Adolescents,
Leipzig, Germany of dyslipidaemia (43% vs 24%, P<0.01) and hy-
pertension (28% vs 10%, P<0.01) than did type 1 dia-
O. Seewi betic patients. More than 25% of the type 2 diabetic
University Children’s Hospital,
Cologne, Germany patients were on insulin treatment.
The annual rate of diagnosis and registration in the
T. Reinehr
Children’s Hospital, Datteln,
DPV database has increased for T2 DM since 1996,
University of Witten/Herdecke, compared with the more stable frequency of T1 DM.
Witten/Herdecke, Germany The major increase for T2 DM was observed in the age
706
Table 1 Clinical characteristics
of patients <20 years of age Characteristic
with diabetes type 1 and type 2
documented in the DPV Number (%)
database (SD standard Male patients (%)
deviation, SDS standard Age at diagnosis (years ) (mean + SD)
deviation score, NS not BMI SDS (mean + SD)
significant) Height SDS (mean + SD)
HbA1C (mean + SD)
group older than 10 years, from 0.8% in 1996 to 3.3% in
2003 (P<0.001).
Discussion
This is the first prospective report on T2 DM in children
and adolescents in Germany based on a large cohort of
diabetic patients. Of the newly diagnosed diabetic pa-
tients in the age group under 20 years, 0.9% suffer from
T2 DM, a prevalence comparable to that in Great
Britain [1], Austria [5] and France [4] but much lower
than in the USA [2] or Japan [3].
Improved awareness and reporting might have con-
tributed to the observed increase, but, on the other hand,
there was a clear increase in the risk factor obesity in our
region during the preceding decades [6]. Whether
European populations will face a similar steep increase
as the USA is unclear. Paediatricians need to be aware
that T1 DM is not the only form of diabetes in children.
T2 DM should be considered in obese children with a
family history positive for T2 DM, especially in girls and
in ethnic at-risk groups.
Acknowledgments This work was supported by grants from the
German Ministry of Health, the German Diabetes Foundation, the
German Diabetes Association, the Dr. Dr. Buerger-Buesing
Foundation and Novo Nordisk Pharma GmbH. We thank the
following centres for participating in the study: Aachen Kinder-
klinik RWTH; Ahlen St. Franziskus Kinderklinik; Aue Helios
Kinderklinik; Augsburg Kinderklinik Zentralklinikum; Aurich
Kinderklinik; Bad Hersfeld Kinderklinik; Bad Oeynhausen Dia-
betesfachklinik; Berlin Kinderklinik Lindenhof; Berlin Klinik St.
Hedwig Innere; Berlin Virchow-Kinderklinik; Berlin Hellersdorf
Innere; Bielefeld Kinderklinik Gilead; Bonn Uni-Kinderklinik;
Bottrop Kinderklinik; Bottrop Knappschaftskrankenhaus Innere;
Bremen Kinderklinik Nord; Bremen Kinderklinik St. Jürgenst-
rasse; Bremen Epidemiologieprojekt; Bremerhaven Kinderklinik;
Bruckmühl Internist Praxis; Celle Kinderklinik; Chemnitz Kin-
derklinik; Coesfeld Kinderklinik; Darmstadt Kinderklinik Prinz
Margareth; Datteln Kinderklinik; Deggendorf Kinderarztpraxis;
Deggendorf Kinderklinik; Delmenhorst Kinderklinik; Detmold
Kinderklinik; Dortmund Kinderklinik; Dortmund St. Josefshos-
pital Innere; Dresden Uni-Kinderklinik; Düren-Birkesdorf Kin-
derklinik; Düsseldorf Uni-Kinderklinik; Erfurt Kinderklinik;
Erlangen Uni-Kinderklinik; Essen Uni-Kinderklinik; Esslingen
Städtische Kinderklinik; Eutin Kinderklinik; Eutin St. Elisabeth
Innere; Freiburg Uni-Kinderklinik; Friedrichshafen Kinderklinik;
Fulda Kinderklinik; Fürth Kinderklinik; Gaissach Kinder-Fach-
klinik; Garmisch-Partenkirchen Kinderklinik; Gelsenkirchen Kin-
derklinik Marienhospital; Gemeinschaftspraxis Rastatt; Giessen
Uni-Kinderklinik; Göppingen Kinderklinik am Eichert; Görlitz
Städtische Kinderklinik; Göttingen Uni-Kinderklinik; Hachenburg
Kinderpraxis; Hagen Kinderklinik; Halle Uni-Kinderklinik; Halle-
Dölau Städtisches Krankenhaus; Hamburg Altonaer Kinderklinik;
Hamburg Kinderklinik Wilhelmstift; Hamburg-Nord Kinderklinik
Diabetes type 1 Diabetes type 2 P
24,871 (96.8) 227 ( 0.9 ) <0.01
52 32 <0.01
8.23+4.1 13.0 +3.4 <0.01
0.45+0.95 1.90+1.25 <0.01
0.10+1.09 0.20+1.59 NS
8.7+2.5 7.4+2.5 <0.01
Heidberg; Hamm Kinderklinik; Hanau Kinderklinik; Hannover
Henriettenstift Innere; Hannover Kinderklinik MHH; Hannover
Kinderklinik auf der Bult; Heidelberg Uni-Kinderklinik; Heiden-
heim Kinderklinik; Heilbronn Innere Klinik; Herford Kinderkli-
nik; Hermeskeis Kinderpraxis; Herzberg Kreiskrankenhaus Innere;
Hildesheim Kinderarztpraxis; Hildesheim Kinderklinik; Hin-
richsegen-Bruckmühl Diabetikerjugendhaus; Homburg Uni-Kin-
derklinik Saarland; Itzehoe Kinderklinik; Jena Uni-Kinderklinik;
Kaiserslautern-Westpfalzklinikum Kinderklinik; Karlsburg Dia-
betesfachklinik; Karlsruhe Städtische Kinderklinik; Kassel Kin-
derklinik Park Schönfeld; Kassel Städtische Kinderklinik; Kempen
Heilig Geist Innere; Kiel Städtische Kinderklinik; Koblenz Kem-
perhof 1. Med. Klinik; Koblenz Kinderklinik Kemperhof; Kon-
stanz Innere Klinik; Krefeld Innere Klinik; Köln Uni-Kinderklinik;
Landshut Kinderklinik; Leipzig Uni-Kinderklinik; Lingen Kin-
derklinik St. Bonifatius; Lippstadt Evangelische Kinderklinik;
Ludwigsburg Kinderklinik; Ludwigshafen Kinderklinik St.Anna-
Stift; Lübeck Uni-Kinderklinik; Lübeck Uni-Klinik Innere Medi-
zin; Lüdenscheid Kinderklinik; Magdeburg Uni-Kinderklinik;
Mannheim Innere; Mannheim Uni-Kinderklinik; Marburg Uni-
Kinderklinik; Mechernich Kinderklinik; Minden Kinderklinik;
Moers Kinderklinik; Mutterstadt Kinderarztpraxis; Mönchen-
gladbach Kinderklinik Rheydt Elisabethkrankenhaus; München
von Haunersche Kinderklinik; München-Harlaching Kinderklinik;
München-Schwabing Kinderklinik; Münster Uni-Kinderklinik;
Münster Kinderarztpraxis; Neukirchen Kinderklinik Kohlhof;
Neuss Lukaskrankenhaus Kinderklinik; Neuwied Kinderklinik
Elisabeth; Nürnberg Cnopfsche Kinderklinik; Nürnberg Kinder-
klinik Klinikum Süd; Oberhausen Kinderklinik; Offenbach/Main
Kinderklinik; Oldenburg Kinderklinik; Osnabrück Kinderklinik;
Paderborn St. Vincenz Kinderklinik; Passau Kinderklinik; Pforz-
heim Kinderklinik; Praxis Wagner, Saaldorf-Surheim; Ravensburg
Kinderklink St. Nikolaus; Regensburg Kinderklinik St. Hedwig;
Remscheid Kinderklinik; Rendsburg Kinderklinik; Rosenheim
Kinderklinik; Rotenburg/Wümme Kinderklinik; Saalfeld Thürin-
genklinik Kinderklinik; Saarbrücken Kinderklinik Winterberg;
Saarlouis Kinderklinik; Schw. Gmünd Margaritenhospital Kin-
derklinik; Schweinfurt Kinderklinik; Siegen Kinderklinik; Singen-
Hegauklinik Kinderklinik; Sinsheim Innere; Spaichingen Innere;
Stade Kinderklinik; Stuttgart Olgahospital Kinderklinik; Suhl
Kinderklinik; Sylt Rehaklinik; Trier Kinderklinik der Borromäer-
innen; Ulm Uni-Kinderklinik; Vechta Kinderklinik; Viersen Kin-
derklinik; Waiblingen Kinderklinik; Waldshut Kinderpraxis
Biberbau; Weiden Kinderklinik; Weingarten Kinderarztpraxis;
Wien Uni-Kinderklinik; Wiesbaden Horst-Schmidt-Kinderklini-
ken; Wiesbaden Kinderklinik DKD; Witten-Herdecke Kinderkli-
nik; Worms Kinderklinik; Wuppertal Kinderklinik.
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