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Continuing stability of center differences in pediatric diabetes care: Do advances in diabetes treatment improve outcome? The Hvidoere study group on childhood diabetes

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de Beaufort, CE and Swift, PGF and Skinner, TC and Aanstoot, HJ and Aman, J and Cameron, F and Martul, P and Chiarelli, F and Daneman, D and Danne, T and Dorchy, H and Hoey, H and Kaprio, EA and Kaufman, F and Kocova, M and Mortensen, HB and Njolstad, PR and Phillip, M and Robertson, KJ and Schoenle, EJ and Urakami, T and Vanelli, M, Hvidoere Study Group on Childhood Diabetes, Continuing stability of center differences in pediatric diabetes care: Do advances in diabetes treatment improve outcome? The Hvidoere study group on childhood diabetes, Diabetes Care, 30, (9) pp. 2245-2250. ISSN 0149-5992 (2007) [Refereed Article]


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Copyight 2007 American Diabetes Association

DOI: doi:10.2337/dc07-0475

Abstract

OBJECTIVE- To reevaluate the persistence and stability of previously observed differences between pediatric diabetes centers and to investigate the influence of demography, language communication problems, and changes in insulin regimens on metabolic outcome, hypoglycemia, and ketoacidosis. RESEARCH DESIGN AND METHODS - This was an observational cross-sectional international study in 21 centers, with clinical data obtained from all participants and A1C levels assayed in one central laboratory. All individuals with diabetes aged 11-18 years (49.4% female), with duration of diabetes of at least 1 year, were invited to participate. Fourteen of the centers participated in previous Hvidoere Studies, allowing direct comparison of glycemic control across centers between 1998 and 2005. RESULTS - Mean A1C was 8.2 ± 1.4%, with substantial variation between centers (mean A1C range 7.4 -9.2%; P < 0.001). There were no significant differences between centers in rates of severe hypoglycemia or diabetic ketoacidosis. Language difficulties had a significant negative impact on metabolic outcome (A1C 8.5 ± 2.0% vs. 8.2 ± 1.4% for those with language difficulties vs. those without, respectively; P < 0.05). After adjustement for significant confounders of age, sex, duration of diabetes, insulin regimen, insulin dose, BMI, and language difficulties, the center differences persisted, and the effect size for center was not reduced. Relative center ranking since 1998 has remained stable, with no significant change in A1C. CONCLUSIONS - Despite many changes in diabetes management, major differences in metabolic outcome between 21 international pediatric diabetes centers persist. Different application between centers in the implementation of insulin treatment appears to be of more importance and needs further exploration. © 2007 by the American Diabetes Association.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Paediatrics and Reproductive Medicine
Research Field:Paediatrics
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Diabetes
Author:Skinner, TC (Professor Timothy Skinner)
ID Code:74175
Year Published:2007
Web of Science® Times Cited:118
Deposited By:Research Division
Deposited On:2011-11-15
Last Modified:2012-06-27
Downloads:0

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