The aim of the study was to explore the metabolic characteristics and outcome parameters in youth with type 1 diabetes and anxiety disorders. HbA1c levels, rates of severe hypoglycemia, diabetic ketoacidosis (DKA), and hospital admission in children, adolescents, and young adults with type 1 diabetes and an anxiety disorder from 431 diabetes‐care‐centers participating in the nationwide German/Austrian/Swiss/Luxembourgian diabetes survey DPV were analyzed and compared with youth without anxiety disorders. Children, adolescents, and young adults with type 1 diabetes and anxiety disorders (n = 1325) had significantly higher HbA1c (8.5% vs. 8.2%), higher rates of DKA (4.2 vs. 2.5 per 100 patient‐years), and higher hospital admission rates (63.6 vs. 40.0 per 100 patient‐years) than youth without anxiety disorders (all p < 0.001). Rates of severe hypoglycemia did not differ. Individuals with anxiety disorders other than needle phobia (n = 771) had higher rates of DKA compared to those without anxiety disorders (4.2 vs. 2.5 per 100 patient‐years, p = 0.003) whereas the rate of DKA in individuals with needle phobia (n = 555) was not significantly different compared to those without anxiety disorders. Children, adolescents, and young adults with anxiety disorders other than needle phobia had higher hospitalization rates (73.7 vs. 51.4 per 100 patient‐years) and more inpatient days (13.2 vs. 10.1 days) compared to those with needle phobia (all p < 0.001). Children, adolescents, and young adults with type 1 diabetes and anxiety disorders had worse glycemic control, higher rates of DKA, and more hospitalizations compared to those without anxiety disorders. Because of the considerable consequences, clinicians should screen for comorbid anxiety disorders in youth with type 1 diabetes.

Objective To assess the role of previous episodes of diabetic ketoacidosis (DKA) and their time‐lag as risk factors for recurring DKA in youth with type 1 diabetes (T1D). Research Design and Methods In a population‐based analysis, data from 29,325 children and adolescents with T1D and at least 5 years of continuous follow‐up were retrieved from the “Diabetes Prospective Follow‐up” (DPV) multi‐center registry in March 2020. Statistical analyses included unadjusted comparisons, logistic and negative binomial regression models. Results Among 29,325 patients with T1D, 86.0% (n = 25,219) reported no DKA, 9.7% (n = 2,833) one, and 4.3% (n = 1,273) more than one episode, corresponding to a DKA rate of 4.4 [95% CI: 4.3–4.6] per 100 patient‐years. Female sex, migratory background, higher HbA1c values, higher daily insulin doses, a lower glucose monitoring frequency, and less CGM usage were associated with DKA. In patients with a previous episode, the DKA rate in the most recent year was significantly higher than in patients with no DKA (17.6 [15.9–19.5] vs. 2.8 [2.7–3.1] per 100 patient‐years; p < 0.001). Multiple DKAs further increased the recurrence rate. The risk for DKA in the most recent year was higher in patients with an episode in the preceding year than in patients with no previous DKA (OR: 10.0 [95% CI: 8.6–11.8]), and remained significantly elevated 4 years after an episode (OR: 2.3 [1.6–3.1]; p < 0.001). Conclusions Each episode of DKA is an independent risk factor for recurrence, even 4 years after an event, underlining the importance of a close follow‐up after each episode.

Aims: To compare diabetes patients with hyperglycaemic hyperosmolar state (HHS), diabetic ketoacidosis (DKA), and patients without decompensation (ND). Methods: In total, 500,973 patients with type 1 or type 2 diabetes of all ages registered in the diabetes patient follow-up (DPV) were included. Analysis was stratified by age (≤ / > 20 years) and by manifestation/follow-up. Patients were categorized into three groups: HHS or DKA—during follow-up according to the most recent episode—or ND. Results: At onset of diabetes, HHS criteria were met by 345 (68.4% T1D) and DKA by 9824 (97.6% T1D) patients. DKA patients had a lower BMI(-SDS) in both diabetes types compared to ND. HbA1c was higher in HHS/DKA. During follow-up, HHS occurred in 1451 (42.2% T1D) and DKA in 8389 patients (76.7% T1D). In paediatric T1D, HHS/DKA was associated with younger age, depression, and dyslipidemia. Pump usage was less frequent in DKA patients. In adult T1D/T2D subjects, metabolic control was worse in patients with HHS/DKA. HHS and DKA were also associated with excessive alcohol intake, dementia, stroke, chronic kidney disease, and depression. Conclusions: HHS/DKA occurred mostly in T1D and younger patients. However, both also occurred in T2D, which is of great importance in the treatment of diabetes. Better education programmes are necessary to prevent decompensation and comorbidities.

Aims: To describe clinical characteristics, treatment patterns and glucagon‐like peptide‐1 receptor agonist (GLP‐1 RA) persistence in individuals with type 2 diabetes (T2D) initiating their first GLP‐1 RA. Materials and Methods: A real‐world analysis of adults with T2D initiating GLP‐1 RA therapy between 2007 and June 2020 from the multicentre Diabetes Prospective Follow‐Up (DPV) Registry, stratified by antidiabetes therapy at the time of GLP‐1 RA initiation: oral antidiabetic drugs (OAD), insulin ± OAD or lifestyle modification (LM). GLP‐1 RA treatment persistence in individuals with ≥12 months follow‐up was determined by Kaplan‐Meier analysis. Results: Overall, 15 111 individuals with T2D initiating GLP‐1 RA therapy (55% men) were identified; median [interquartile range (IQR)] age [58.7 (50.6‐66.7) years], diabetes duration [8.5 (3.6‐14.7) years], glycated haemoglobin [HbA1c; 8.2 (7.1‐9.8)%]. Median (95% confidence interval) GLP‐1 RA persistence in eligible individuals (n = 5189) was 11 (10‐12) months; OAD 12 (11‐14) months (n = 2453); insulin ± OAD 11 (9‐12) months (n = 2204); and LM 7 (5‐9) months (n = 532). Median treatment persistence tended to increase from 2007‐2012 to 2017‐2020. Median (IQR) HbA1c decreased from baseline [8.2 (7.1‐9.8)%] to discontinuation [7.5 (6.6‐8.7)%], with a greater decrease observed in individuals with persistence >12 months versus ≤12 months. Individuals who discontinued GLP‐1 RA therapy predominantly switched to insulin (if not already using) or dipeptidyl peptidase‐4 inhibitors. Conclusion: Real‐world registry data revealed improved outcomes with longer median GLP‐1 RA persistence; ~50% of patients overall achieved HbA1c <7% at 12 months. Persistence was highest with baseline OAD and/or insulin, and tended to increase over the period 2007‐2020.