Persistent Differences Among Centers Over 3 Years in Glycemic Control and Hypoglycemia in a Study of 3,805 Children and Adolescents With Type 1 Diabetes From the Hvidøre Study Group
| Autor: | Jan Åman, Kenneth Robertson, Maurizio Vanelli, Stephen Greene, Oddmund Søvik, Patrick Garandeau, Henk-Jan Aanstoot, Mirjana Kocova, Reinhard W. Holl, Nobuo Matsuura, Thomas Danne, Hilary Hoey, Henrik B. Mortensen, Philip Hougaard, Eugen J. Schoenle, Francesco Chiarelli, Rosa Maria Tsou, Pedro Martul, Eero A. Kaprio, Peter G.F. Swift, Denis Daneman, Harry Dorchy, Helle Lynggaard |
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| Rok vydání: | 2001 |
| Předmět: |
Blood Glucose
Male medicine.medical_specialty Pediatrics Adolescent Cross-sectional study Endocrinology Diabetes and Metabolism medicine.medical_treatment Hypoglycemia Japan Diabetes mellitus Internal Medicine Humans Insulin Medicine Child Glycemic Glycated Hemoglobin Advanced and Specialized Nursing Type 1 diabetes business.industry Incidence Incidence (epidemiology) Reproducibility of Results medicine.disease Surgery Europe Cross-Sectional Studies Diabetes Mellitus Type 1 Metabolic control analysis North America Female business Biomarkers |
| Zdroj: | Diabetes Care. 24:1342-1347 |
| ISSN: | 1935-5548 0149-5992 |
| Popis: | OBJECTIVE—Twenty-one international pediatric diabetes centers from 17 countries investigated the effect of simple feedback about the grand mean HbA1c level of all centers and the average value of each center on changes in metabolic control, rate of severe hypoglycemia, and insulin therapy over a 3-year period. RESEARCH DESIGN AND METHODS—Clinical data collection and determination of HbA1c levels were conducted at a central location in 1995 (n = 2,780, age 0–18 years) and 1998 (n = 2,101, age 11–18 years). RESULTS—Striking differences in average HbA1c concentrations were found among centers; these differences remained after adjustment for the significant confounders of sex, age, and diabetes duration. They were apparent even in patients with short diabetes duration and remained stable 3 years later (mean adjusted HbA1c level: 8.62 ± 0.03 vs. 8.67 ± 0.04 [1995 vs. 1998, respectively]). Three centers had improved significantly, four centers had deteriorated significantly in their overall adjusted HbA1c levels, and 14 centers had not changed in glycemic control. During the observation period, there were increases in the adjusted insulin dose by 0.076 U/kg, the adjusted number of injections by 0.23 injections per day, and the adjusted BMI by 0.95 kg/m2. The 1995 versus 1998 difference in glycemic control for the seven centers could not be explained by prevailing insulin regimens or rates of hypoglycemia. CONCLUSIONS—This study reveals significant outcome differences among large international pediatric diabetes centers. Feedback and comparison of HbA1c levels led to an intensification of insulin therapy in most centers, but improved glycemic control in only a few. |
| Databáze: | OpenAIRE |
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