Lessons from the Hvidoere International Study Group on childhood diabetes: Be dogmatic about outcome and flexible in approach

Type 1 diabetes is one of the most commonchronic diseases of childhood. Between 1989 and 2003, the incidence of type 1 diabetes in youth increased at approximately 3.9% per year with a projected doubling of cases in children aged <5 yr between 2005 and 2015 (1). This has substantial impact on those affected, their families, on pediatric diabetes care, and on national health care budgets. Much has changed over the last decade in terms of management strategies in type 1 diabetes, however, as Edwin Gale editorialized in 2005 that the challenges of diabetes remain much the same (2). In short, there are more cases resulting in increasing disease years characterized by greater medical and psychosocial complexity.

The Hvidoere International Study Group on Childhood Diabetes evolved in 1994 during a meeting that was held in the immediate post Diabetes Control and Complication Trial (DCCT, 3) era to discuss strategies that could improve the quality of pediatric diabetes care and thereby improve subsequent adult outcomes. The objectives and mission statement of the Hvidoere group can be found on its website http://www.hvidoeregroup.org/. In short, this unique collaboration of 26 pediatric diabetes centers from 23 countries (Europe, North America, Japan, and Australia) has undertaken a series of research projects investigating critical determinants for long-term outcome of type 1 diabetes care discriminating in terms of outcomes and which aspects of care are universally effective. In all the Hvidoere studies, HbA1c was analyzed centrally at the Steno Diabetes Center, Denmark. In the period from 1997 to December 2002 HbA1c was analyzed using an automated high pressure liquid chromatographic method (Bio-Rad Variant, Bio-Rad Laboratories, Hercules, CA, USA) using the same calibrator lots as the DCCT laboratory. From 2003 till now, HbA1c was analyzed by the DCCT aligned TOSOH Automated Glycohemoglobin Analyzer HLC-723G7, Tosoh Corporation, Tokyo, Japan.

Five major studies have been undertaken, both crosssectional and longitudinal, serving this goal. The findings detailed below show that these studies have led to an internationally recognized remission parameter (4) and have validated well-being and quality-of-life (QOL) questionnaires (with relevant translation, (5). The key thematic and practical findings of this body of work (published in 28 peer reviewed medical and scientific journals) are summarized in this review.