Type 1 diabetes is one of the most complex chronic conditions in childhood. Its management requires not only medical expertise but also a high level of commitment from parents. Medical recommendations are often not adequately followed—among other reasons, due to the socioeconomic background of the families. Children from less privileged backgrounds tend to have poorer health outcomes. Despite this well-known issue, there are still few studies that holistically analyze the treatment trajectories of this young population over a longer period of time.
This research gap is addressed by a new study led by Prof. Dr. Leonie Sundmacher, head of the Associate Professor of Health Economics, in collaboration with her research team Christopher Nußbaum, Anna Novelli, and Amelie Flothow. The aim of the research team was to evaluate patterns in care trajectories among children with type 1 diabetes. The findings were published under the title "Exploring patterns in pediatric type 1 diabetes care and the impact of socioeconomic status" in the journal BMC Medicine.
Routine data from the German health insurer Techniker Krankenkasse provided the basis for the study. A method called sequence analysis followed by a cluster algorithm was applied. Originally developed in the social sciences, this methodology is increasingly being used in health services research to capture care trajectories over time in a differentiated manner. The analysis included health insurance data from around 900 children aged 11 to 14 from the years 2017 to 2019.
Based on this data, Prof. Sundmacher’s team identified two groups: one cluster characterized by guideline-compliant care, and another showing significant deficiencies. About a quarter of the children received medical care over the three-year period that did not meet recommended standards in several respects—for example, less frequent HbA1c tests or missing important preventive check-ups such as retinopathy screening. Strikingly, these deficiencies occurred despite regular visits to doctors.
“Our findings show that regular contact with the healthcare system does not automatically guarantee care that follows clinical guidelines,” emphasizes Christopher Nußbaum. A central risk factor for insufficient treatment was the socioeconomic status of the parents. Children from families with low educational attainment or parental unemployment were significantly more likely to fall into the cluster with care deficits. Conversely, participation in a Disease Management Program (DMP) significantly increased the likelihood of receiving care in line with clinical guidelines.
“It is encouraging that DMPs appear to have a positive effect on the quality of care. However, our analysis also shows that social disparities have a substantial influence on actual care,” concludes Prof. Sundmacher. The reasons for this may lie in regional shortages as well as structural barriers to accessing specialized services.
With their work, the research team not only contributes new insights into the real-world medical care of children with type 1 diabetes in Germany but also opens up new methodological avenues for investigating complex care pathways. The use of multidimensional sequence analysis makes it possible to examine care trajectories not just at isolated points in time, but across multiple dimensions over time—a promising approach that could also be highly relevant for other chronic diseases.
To the homepage of the Associate Professorship of Health Economics (CHEC)
Contact:
Prof. Dr. Leonie Sundmacher
Associate Professorship of Health Economics (CHEC)
Georg-Brauchle Ring 60/62
80992 München
phone: 089 289 24464
e-Mail: leonie.sundmacher(at)tum.de
Christopher Nußbaum
Associate Professorship of Health Economics (CHEC)
Georg-Brauchle Ring 60/62
80992 München
E-Mail: christopher.buehler(at)tum.de
Text: Jasmin Schol / Christopher Nußbaum
Photos: private / Unsplash