Prescriptions for insulin and insulin analogues in children
with and without major congenital anomalies: a data linkage cohort
study across six European regions
Children with Down syndrome have been reported to have an increased risk of developing diabetes. We don’t know if children with other congenital anomalies are also at increased risk. This EUROlinkCAT study examined insulin/insulin analogues (synthetic insulin) prescriptions for 60,662 children with major congenital anomalies and 1,722,912 children without congenital anomalies as an indicator of diabetes. The children came from six regions in five European countries and were born between 2000 and 2014. Children were followed up to their tenth birthday or 31/12/2015 whichever came first, with the mean follow-up 6.2 years.
This study found that at 0-3 years, 4 out of every 10,000 years a child with congenital anomalies had more than one insulin/insulin analogue prescription. This was very similar to 3 out of every 10,000 years in children without congenital anomalies. By the time children had reached 8-9 years this had increased ten-fold. Children with non-chromosomal anomalies had a similar risk of having insulin/insulin analogue prescriptions between 0-9 years as children without congenital anomalies. However, children with chromosomal anomalies had 2.4 times the risk of having >1 prescription for insulin/insulin analogues at 0-9 years compared to children without congenital anomalies. This was even higher for children with Down syndrome (3.4 times the risk), Down syndrome with congenital heart defects (3.9 times the risk) and Down syndrome without congenital heart defects (2.8 times the risk) when compared to children without congenital anomalies. Girls had a decreased risk of having >1 prescription for insulin/insulin analogues aged 0-9 years compared to boys (with 76% of the risk seen in boys for girls with congenital anomalies and 90% of the risk seen for boys in girls without congenital anomalies). In children without congenital anomalies those born prematurely (<37 weeks) were 28% more likely to have >1 insulin/insulin analogue prescription compared to those born at term.
These results will help doctors and nurses to identify which congenital anomalies are associated with an increased risk of developing diabetes requiring insulin therapy. It will also allow them to reassure families of children who have non-chromosomal anomalies that their risk is similar to that of the general population.