1
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Steineck IIK, Anderzén J, Eeg-Olofsson K, Ekelund J, Gudbjörnsdottir S, Hanberger L, Nåtman J, Pundziute Lyckå A, Samuelsson U, Särnblad S, Åkesson K, Hanas R. First year national Swedish paediatric Hba1c data are at the level of several intervention studies: Results from a Swedish nationwide diabetes register study. Diabetes Res Clin Pract 2024; 216:111807. [PMID: 39117042 DOI: 10.1016/j.diabres.2024.111807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/31/2024] [Accepted: 08/03/2024] [Indexed: 08/10/2024]
Abstract
AIMS/HYPOTHESIS To study the progression of HbA1c after diagnosis of type 1 diabetes in children and adolescents during 2010-2019 with emphasis on HbA1c nadir 3-6 months after onset. METHODS Partial funding was secured for this study. The Swedish paediatric diabetes quality register SWEDIABKIDS has >95 % coverage of type 1 diabetes up to 18 years. A mixed model for repeated measurements was used to estimate differences in HbA1c between onset year periods. RESULTS We followed 6,891 patients over two years from onset (48,292 HbA1c values). We found a gradual decrease in mean HbA1c 24 months after onset from 56.0 mmol/mol (7.28 %) in 2010/11 to 50.5 mmol/mol (6.77 %) in 2018/19, which is at the level of several recent intervention studies. The initial drop in HbA1c from onset until 3 and 6 months has become more pronounced in recent years. There was a significant positive correlation between HbA1c at 3 and 6 months with 12, 18 and 24 months. Percentage of severe hypoglycaemic coma was higher (5.1 % vs 3.4 %; p = 0.023) in 2010/2011 than 2018/2019, but the absolute risk of ketoacidosis was essentially unchanged, (1.5 % to 0.8 %, p = 0.110) CONCLUSIONS/INTERPRETATION: There was a continuous decrease in HbA1c over the study period 2010-2019, which coincides in time with an increased use of diabetes technology and lowering the HbA1c target to 48 mmol/mol (6.5 %). The decrease in 2-year HbA1c was preceded by a lower HbA1c nadir, which may set the trajectories for coming HbA1c and be a modifiable factor for a long-term improvement in metabolic control.
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Affiliation(s)
- Isabelle I K Steineck
- Department of Endocrinology, Steno Diabetes Center Copenhagen, Gentofte, Denmark; Department of Endocrinology, Hvidovre Hospital, Copenhagen, Denmark
| | - Johan Anderzén
- Department of Paediatrics, Ryhov County Hospital, Jönköping, Sweden
| | - Katarina Eeg-Olofsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Center of Registers Västra Götaland, Gothenburg, Sweden
| | - Jan Ekelund
- Center of Registers Västra Götaland, Gothenburg, Sweden
| | | | - Lena Hanberger
- Department of Health, Medicine, and Caring Sciences, Division of Nursing and Reproductive Health, Linköping University, Linköping, Sweden
| | | | - Auste Pundziute Lyckå
- Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulf Samuelsson
- Department of Paediatrics, Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Stefan Särnblad
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden; Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Karin Åkesson
- Department of Paediatrics, Ryhov County Hospital, Jönköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ragnar Hanas
- Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Sweden; Department of Paediatrics, NU Hospital Group, Uddevalla Hospital, Uddevalla, Sweden.
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2
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Jelleryd E, Brorsson AL, Smart CE, Käck U, Lindholm Olinder A. Carbohydrate Counting, Empowerment and Glycemic Outcomes in Adolescents and Young Adults with Long Duration of Type 1 Diabetes. Nutrients 2023; 15:4825. [PMID: 38004219 PMCID: PMC10675281 DOI: 10.3390/nu15224825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
The complex treatment for diabetes type 1 (T1D) includes insulin dosing for every meal, which requires education and experience to achieve optimal outcomes. Advanced carbohydrate counting (ACC) is the recommended method. We studied ACC as part of a standard treatment with the aim to explore its associations with glycemic control and empowerment in adolescents and young adults. We used national registry data on glycemic outcomes, a study-specific questionnaire regarding the use of ACC and the Gothenburg Young Persons Empowerment Scale (GYPES) to measure empowerment. A total of 111 participants (10-28 years of age, diabetes duration >9 years, mean HbA1c of 55.4 mmol/mol) answered the questionnaire. We found that most participants (79.3%) who learn ACC, at onset or later, continue to use the method. A higher level of empowerment was associated with lower HbA1c (p = 0.021), making patient empowerment an important factor in achieving optimal glycemic outcomes. No associations were found between ACC and empowerment or glycemic outcomes. A mixed strategy, only using ACC sometimes when insulin dosing for meals, was associated with the lowest empowerment score and highest HbA1c and should warrant extra education and support from the diabetes team to reinforce a dosing strategy.
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Affiliation(s)
- Elisabeth Jelleryd
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 11883 Stockholm, Sweden; (U.K.); (A.L.O.)
- Women’s Health and Allied Health Professionals Theme, Medical Unit Clinical Nutrition, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Anna Lena Brorsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, 14152 Stockholm, Sweden;
| | - Carmel E. Smart
- Department of Endocrinology, John Hunter Children’s Hospital, Newcastle, NSW 2305, Australia;
- School of Health Sciences, University of Newcastle, Newcastle, NSW 2300, Australia
| | - Ulrika Käck
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 11883 Stockholm, Sweden; (U.K.); (A.L.O.)
- Sachs’ Children and Youth Hospital, Södersjukhuset, 11883 Stockholm, Sweden
| | - Anna Lindholm Olinder
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 11883 Stockholm, Sweden; (U.K.); (A.L.O.)
- Sachs’ Children and Youth Hospital, Södersjukhuset, 11883 Stockholm, Sweden
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3
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Sundberg F, deBeaufort C, Krogvold L, Patton S, Piloya T, Smart C, Van Name M, Weissberg-Benchell J, Silva J, diMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Managing diabetes in preschoolers. Pediatr Diabetes 2022; 23:1496-1511. [PMID: 36537520 PMCID: PMC10108244 DOI: 10.1111/pedi.13427] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Frida Sundberg
- The Queen Silvia Childrens Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Pediatrics, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Carine deBeaufort
- Clinique Pédiatrique, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.,Department of Pediatric Endocrinology, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Lars Krogvold
- Paediatric Department, Oslo University Hospital, Oslo, Norway
| | - Susana Patton
- Center for Healthcare Delivery Science, Nemours Children's Health, Jacksonville, Florida, USA
| | - Thereza Piloya
- Department of Paediatrics & Child Health, School of Medicine, College of Health Sciences Makerere University, Kampala, Uganda
| | - Carmel Smart
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital and School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | | | - Jill Weissberg-Benchell
- Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jose Silva
- SummitStone Health Partners, Fort Collins, Colorado, USA
| | - Linda A diMeglio
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
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4
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Lanzinger S, Zimmermann A, Ranjan AG, Gani O, Pons Perez S, Akesson K, Majidi S, Witsch M, Hofer S, Johnson S, Pilgaard KA, Kummernes SJ, Robinson H, Eeg-Olofsson K, Ebekozien O, Holl RW, Svensson J, Skrivarhaug T, Warner J, Craig ME, Maahs D. A collaborative comparison of international pediatric diabetes registries. Pediatr Diabetes 2022; 23:627-640. [PMID: 35561091 DOI: 10.1111/pedi.13362] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/24/2022] [Accepted: 05/04/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND An estimated 1.1 million children and adolescents aged under 20 years have type 1 diabetes worldwide. Principal investigators from seven well-established longitudinal pediatric diabetes registries and the SWEET initiative have come together to provide an international collaborative perspective and comparison of the registries. WORK FLOW Information and data including registry characteristics, pediatric participant clinical characteristics, data availability and data completeness from the Australasian Diabetes Data Network (ADDN), Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids), Diabetes prospective follow-up registry (DPV), Norwegian Childhood Diabetes Registry (NCDR), National Paediatric Diabetes Audit (NPDA), Swedish Childhood Diabetes Registry (Swediabkids), T1D Exchange Quality Improvement Collaborative (T1DX-QI), and the SWEET initiative was extracted up until 31 December 2020. REGISTRY OBJECTIVES AND OUTCOMES The seven diabetes registries and the SWEET initiative collectively show data of more than 900 centers and around 100,000 pediatric patients, the majority with type 1 diabetes. All share the common objectives of monitoring treatment and longitudinal outcomes, promoting quality improvement and equality in diabetes care and enabling clinical research. All generate regular benchmark reports. Main differences were observed in the definition of the pediatric population, the inclusion of adults, documentation of CGM metrics and collection of raw data files as well as linkage to other data sources. The open benchmarking and access to regularly updated data may prove to be the most important contribution from registries. This study describes aspects of the registries to enable future collaborations and to encourage the development of new registries where they do not exist.
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Affiliation(s)
- Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany.,German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | | | - Ajenthen G Ranjan
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | - Osman Gani
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Karin Akesson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden
| | - Shideh Majidi
- University of Colorado, Barbara Davis Center, Aurora, Colorado, USA
| | - Michael Witsch
- Department of Pediatrics DECCP, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Sabine Hofer
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Kasper A Pilgaard
- Department of Pediatrics and Adolescents, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Siv Janne Kummernes
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Holly Robinson
- Royal College of Paediatrics and Child Health, London, UK
| | - Katarina Eeg-Olofsson
- Swedish National Diabetes Register, Centre of Registers, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Osagie Ebekozien
- T1D Exchange, Boston, Massachusetts, USA.,University of Mississippi School of Population Health, Jackson, Mississippi, USA
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany.,German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Jannet Svensson
- Department of Pediatrics and Adolescents, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torild Skrivarhaug
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Maria E Craig
- Charles Perkins Centre Westmead, University of Sydney, Australia.,The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,University of NSW, Sydney, New South Wales, Australia
| | - David Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA.,Stanford Diabetes Research Center, Stanford, California, USA
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5
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Zaharieva DP, Bishop FK, Maahs DM. Advancements and future directions in the teamwork, targets, technology, and tight control-the 4T study: improving clinical outcomes in newly diagnosed pediatric type 1 diabetes. Curr Opin Pediatr 2022; 34:423-429. [PMID: 35836400 PMCID: PMC9298953 DOI: 10.1097/mop.0000000000001140] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW The benefits of intensive diabetes management have been established by the Diabetes Control and Complications Trial. However, challenges with optimizing glycemic management in youth with type 1 diabetes (T1D) remain across pediatric clinics in the United States. This article will review our Teamwork, Targets, Technology, and Tight Control (4T) study that implements emerging diabetes technology into clinical practice with a team approach to sustain tight glycemic control from the onset of T1D and beyond to optimize clinical outcomes. RECENT FINDINGS During the 4T Pilot study and study 1, our team-based approach to intensive target setting, education, and remote data review has led to significant improvements in hemoglobin A1c throughout the first year of T1D diagnosis in youth, as well as family and provider satisfaction. SUMMARY The next steps include refinement of the current 4T study 1, developing a business case, and broader implementation of the 4T study. In study 2, we are including a more pragmatic cadence of remote data review and disseminating exercise education and activity tracking to both English- and Spanish-speaking families. The overall goal is to create and implement a translatable program that can facilitate better outcomes for pediatric clinics across the USA.
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Affiliation(s)
- Dessi P. Zaharieva
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA
| | - Franziska K. Bishop
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA
| | - David M. Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA
- Stanford Diabetes Research Center, Stanford, CA
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6
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Skipper N, Thingholm PR, Borch L, Gaulke A, Eriksen TLM, Søndergaard C, Svensson J. Center differences in diabetes treatment outcomes among children with type 1 diabetes: A nationwide study of 3866 Danish children. Pediatr Diabetes 2022; 23:73-83. [PMID: 34766429 DOI: 10.1111/pedi.13284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Mean differences in HbA1c across centers are well established, but less well understood. The aim was to assess whether differences in patient case-mix can explain the variation in mean HbA1c between pediatric diabetes centers in Denmark. The association between HbA1c , frequency of blood glucose monitoring (BGM), treatment modality, and center visits was investigated. RESEARCH DESIGN AND METHODS This longitudinal nationwide study included 3866 Danish children with type 1 diabetes from 2013 to 2017 (n = 12,708 child-year observations) from 16 different pediatric diabetes centers. Mean HbA1c , proportion of children reaching HbA1c treatment target (HbA1c ≤ 58 mmol/mol [7.5%]) were compared across centers using linear regression models. This was done with and without adjustment for socioeconomic characteristics (patient case-mix). RESULTS The mean difference in HbA1c during follow-up was 11.6 mmol/mol (95% CI 7.9, 15.3) (1.1% [95% CI 0.7, 1.4]) when comparing the centers with the lowest versus highest mean HbA1c . The difference was attenuated and remained significant after adjustment for the patient case-mix (difference: 10.5 mmol/mol [95% CI 6.8, 14.2] (1.0% [95% CI 0.6, 1.3])). Overall, 6.8% of the differences in mean HbA1c across centers were explained by differences in the patient case-mix. Across centers, more frequent BGM was associated with lower HbA1c . The proportion of insulin pump users and number of visits was not associated with HbA1c . CONCLUSION In a setting of universal health care, large differences in HbA1c across centers were found, and could not be explained by patient background, number of visits or use of technology. Only BGM was associated with center HbA1c .
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Affiliation(s)
- Niels Skipper
- Department of Economics and Business Economics and CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Peter R Thingholm
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Luise Borch
- Department of Pediatrics and Adolescent Medicine, Gødstrup Hospital, Gødstrup, Denmark
| | - Amanda Gaulke
- Department of Economics, Kansas State University, Manhattan, Kansas, USA
| | - Tine L M Eriksen
- VIVE - The Danish Center for Social Science Research, Aarhus, Denmark
| | - Charlotte Søndergaard
- Department of Pediatrics and Adolescent Medicine, Gødstrup Hospital, Gødstrup, Denmark
| | - Jannet Svensson
- Pediatrics and Adolescent Department, Copenhagen University Hospital, Herlev, Denmark
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7
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Svensson J. The ABC of diabetes registries. ENDOCRINOL DIAB NUTR 2021; 68:525-526. [PMID: 34872634 DOI: 10.1016/j.endien.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Jannet Svensson
- Associated professor, Department of Pediatrics and Adolescents Herlev & Gentofte University hospital Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.
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8
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The ABC of diabetes registries. ENDOCRINOL DIAB NUTR 2021. [DOI: 10.1016/j.endinu.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Heikkilä A, Ilanne‐Parikka P, Koivisto V, Ranta K. Teamwork between the clinics and the families improves the care of children and adolescents with diabetes. Acta Paediatr 2021; 110:993-994. [PMID: 32920903 DOI: 10.1111/apa.15569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022]
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10
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Anderzén J, Hermann JM, Samuelsson U, Charalampopoulos D, Svensson J, Skrivarhaug T, Fröhlich-Reiterer E, Maahs DM, Akesson K, Kapellen T, Fritsch M, Birkebaek NH, Drivvoll AK, Miller K, Stephenson T, Hofer SE, Fredheim S, Kummernes SJ, Foster N, Amin R, Hilgard D, Rami-Merhar B, Dahl-Jørgensen K, Clements M, Hanas R, Holl RW, Warner JT. International benchmarking in type 1 diabetes: Large difference in childhood HbA1c between eight high-income countries but similar rise during adolescence-A quality registry study. Pediatr Diabetes 2020; 21:621-627. [PMID: 32249476 DOI: 10.1111/pedi.13014] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/24/2020] [Accepted: 03/29/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To identify differences and similarities in HbA1c levels and patterns regarding age and gender in eight high-income countries. SUBJECTS 66 071 children and adolescents below18 years of age with type 1 diabetes for at least 3 months and at least one HbA1c measurement during the study period. METHODS Pediatric Diabetes Quality Registry data from Austria, Denmark, England, Germany, Norway, Sweden, the United States, and Wales were collected between 2013 and 2014. HbA1c, gender, age, and duration were used in the analysis. RESULTS Distribution of gender and age groups was similar in the eight participating countries. The mean HbA1c varied from 60 to 73 mmol/mol (7.6%-8.8%) between the countries. The increase in HbA1c between the youngest (0-9 years) to the oldest (15-17 years) age group was close to 8 mmol/mol (0.7%) in all countries (P < .001). Females had a 1 mmol/mol (0.1%) higher mean HbA1c than boys (P < .001) in seven out of eight countries. CONCLUSIONS In spite of large differences in the mean HbA1c between countries, a remarkable similarity in the increase of HbA1c from childhood to adolescence was found.
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Affiliation(s)
- Johan Anderzén
- Department of Paediatrics, County Hospital Ryhov, Jönköping, Sweden
| | - Julia M Hermann
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Ulf Samuelsson
- Department of Clinical and Experimental Medicine, Division of Paediatrics and Diabetes, Research Centre, Linköping University Hospital, Linköping, Sweden
| | | | - Jannet Svensson
- Paediatric Department, CPH-Direct, Herlev University Hospital, Herlev, Denmark
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - David M Maahs
- Division of Pediatric Endocrinology and Stanford Diabetes Research Center, Stanford, California, USA
| | - Karin Akesson
- Department of Paediatrics, County Hospital Ryhov, Jönköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Maria Fritsch
- Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Niels H Birkebaek
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Ann K Drivvoll
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kellee Miller
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Terence Stephenson
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Sabine E Hofer
- Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Siri Fredheim
- Paediatric Department, CPH-Direct, Herlev University Hospital, Herlev, Denmark
| | - Siv J Kummernes
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nicole Foster
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Rakesh Amin
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Birgit Rami-Merhar
- Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Knut Dahl-Jørgensen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mark Clements
- Children's Mercy Hospital, Kansas City, Missouri, USA.,University of Missouri, Kansas City, Missouri, USA.,University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ragnar Hanas
- Department of Paediatrics, NU Hospital Group, Uddevalla, Sweden and the Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Justin T Warner
- Department of Paediatric Endocrinology and Diabetes, Children's Hospital for Wales, Cardiff, UK
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11
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DiMeglio LA, Acerini CL, Codner E, Craig ME, Hofer SE, Pillay K, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:105-114. [PMID: 30058221 DOI: 10.1111/pedi.12737] [Citation(s) in RCA: 373] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 07/27/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- Linda A DiMeglio
- Division of Pediatric Endocrinology and Diabetology and Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Ethel Codner
- Institute of Maternal and Child Research (IDMI), School of Medicine, Universidad de Chile, Santiago, Chile
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, Australia
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - David M Maahs
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
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12
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Warner JT. Highs and lows of diabetic care: lessons from a national audit. Arch Dis Child 2018; 103:121-124. [PMID: 28912164 DOI: 10.1136/archdischild-2016-311373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/17/2017] [Accepted: 08/19/2017] [Indexed: 11/04/2022]
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13
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Samuelsson U, Åkesson K, Peterson A, Hanas R, Hanberger L. Continued improvement of metabolic control in Swedish pediatric diabetes care. Pediatr Diabetes 2018; 19:150-157. [PMID: 27807917 DOI: 10.1111/pedi.12467] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/26/2016] [Accepted: 10/05/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To prospectively investigate if the grand mean HbA1c and the differences in mean HbA1c between centers in Sweden could be reduced, thereby improving care delivered by pediatric diabetes teams. METHODS We used an 18-month quality improvement collaborative (QIC) together with the Swedish pediatric diabetes quality registry (SWEDIABKIDS). The first program (IQ-1), started in April 2011 and the second (IQ-2) in April 2012; together they encompassed 70% of Swedish children and adolescents with diabetes. RESULTS The proportion of patients in IQ-1 with a mean HbA1c <7.4% (57 mmol/mol) increased from 26.4% before start to 35.9% at 36 months (P < .001), and from 30.2% to 37.2% (P < .001) for IQ-2. Mean HbA1c decreased in both participating and non-participating (NP) centers in Sweden, thereby indicating an improvement by a spatial spill over effect in NP centers. The grand mean HbA1c decreased by 0.45% (4.9 mmol/mol) during 36 months; at the end of 2014 it was 7.43% (57.7 mmol/mol) (P < .001). A linear regression model with the difference in HbA1c before start and second follow-up as dependent variable showed that QIC participation significantly decreased mean HbA1c both for IQ-1 and IQ-2. The proportion of patients with high HbA1c values (>8.7%, 72 mmol/mol) decreased significantly in both QICs, while it increased in the NP group. CONCLUSIONS The grand mean HbA1c has decreased significantly in Sweden from 2010 to 2014, and QICs have contributed significantly to this decrease. There seems to be a spatial spill-over effect in NP centers.
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Affiliation(s)
- Ulf Samuelsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Karin Åkesson
- Department of Pediatrics, County Hospital Ryhov, Jönköping, Sweden.,The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Anette Peterson
- School of Health and Science, The Jönköping Academy for Improvement of Health and Welfare and Jönköping County Council, Jönköping University, Jönköping, Sweden
| | - Ragnar Hanas
- Department of Pediatrics, NU Hospital Group, Uddevalla Hospital, Uddevalla, Sweden.,The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Lena Hanberger
- Division of Nursing, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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Witsch M, Kosteria I, Kordonouri O, Alonso G, Archinkova M, Besancon S, Birkebæk NH, Bratina N, Cherubini V, Hanas R, Hasnani D, Iotova V, Raposo JF, Schwandt A, Sumnik Z, Svensson J, Veeze H. Possibilities and challenges of a large international benchmarking in pediatric diabetology-The SWEET experience. Pediatr Diabetes 2016; 17 Suppl 23:7-15. [PMID: 27982492 DOI: 10.1111/pedi.12432] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/18/2016] [Accepted: 07/29/2016] [Indexed: 02/05/2023] Open
Abstract
AIM Despite the existence of evidence-based guidelines for the care of children with diabetes, widespread gaps in knowledge, attitude, and practice remain. The purpose of this paper is to present a review of benchmarking practices and results of this process within SWEET, moreover focusing on current challenges and future directions. METHODS Biannually, members electronically transfer de-identified clinic data for 37 parameters to the SWEET database. Each center receives benchmarking and data validation reports. RESULTS In 2015, 48 centers have contributed data for 20 165 unique patients (51.6% male). After exclusion for missing data 19 131 patients remain for further analysis. The median age is 14.2 years, with a median diabetes duration 4.8 years; 96.0% of patients have type 1, 1.1% type 2, and 2.9% other diabetes types. Data completeness has increased over time. In 2015, median HbA1c of all patients' (diabetes type 1) medians was 7.8% (61.7 mmol/mol) with 39.1%, 41.4%, and 19.4% of patients having HbA1c < 7.5% (58 mmol/mol), 7.5%-9% (58-75 mmol/mol) and >9% (75 mmol/mol), respectively. Although HbA1c has been stable over time [7.7%-7.8% (60.7-61.7 mmol/mol)], there remains wide variation between centers. Fourteen centers achieve a median HbA1c <7.5% (58 mmol/mol). CONCLUSIONS Our vision is that the participation in SWEET is encouraging members to deliver increasingly accurate and complete data. Dissemination of results and prospective projects serve as further motivation to improve data reporting. Comparing processes and outcomes will help members identify weaknesses and introduce innovative solutions, resulting in improved and more uniform care for patients with diabetes.
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Affiliation(s)
- Michael Witsch
- DECCP, Clinique Pédiatrique Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Ioanna Kosteria
- Agia Sophia Children's Hospital, University of Athens Medical School, Athens, Greece
| | - Olga Kordonouri
- Diabetes Centre for Children and Adolescents, Kinderkrankenhaus Auf der Bult, Hannover, Germany
| | - Guy Alonso
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, USA
| | - Margarita Archinkova
- Clinic of Endocrinology, Diabetes and Genetics, University Pediatric Hospital, Medical University - Sofia, Bulgaria, Sofia, Bulgaria
| | | | - Niels H Birkebæk
- Department of Paediatrics, Aarhus University Hospital, Skejby, Department of Pediatrics, Aarhus, Denmark
| | - Natasa Bratina
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, Ljubljana, Slovenia
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
| | - Ragnar Hanas
- Department of Pediatrics, NU Hospital Group, Uddevalla, Sweden
| | - Dhruvi Hasnani
- Diacare-Diabetes Care & Hormone Clinic, Ahmedabad, India
| | - Violeta Iotova
- First Clinic of Pediatric Endocrinology, University Hospital 'Sv. Marina', Varna, Bulgaria
| | | | - Anke Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich, Germany
| | - Zdenek Sumnik
- Department of Pediatrics, University Hospital Motol Prague, Prague, Czech Republic
| | - Jannet Svensson
- Pediatric Department, Herlev University Hospital, Copenhagen, Denmark
| | - Henk Veeze
- Centre for Pediatric and Young Adult Diabetes Care and Research, Rotterdam, The Netherlands
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15
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Söderström U, Samuelsson U, Åman J. National Swedish study of immigrant children with type 1 diabetes showed impaired metabolic control after three years of treatment. Acta Paediatr 2016; 105:935-9. [PMID: 27144734 DOI: 10.1111/apa.13456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 02/11/2016] [Accepted: 04/29/2016] [Indexed: 12/16/2022]
Abstract
AIM This study examined the clinical status and socio-demographic conditions of children with type 1 diabetes at baseline and after three years of treatment, comparing those born to immigrant parents and Swedish parents. METHODS This observational nationwide population-based cohort study used prospectively collected registry data from Swediabkids, the National Quality Registry for Paediatric Diabetes in Sweden from 2000 to 2010. Of the 13 415 children with type 1 diabetes, there were 879 born to immigrant parents. We selected three children born to Swedish parents from the same registry for each immigrant child matching them by gender, age and year of diabetes onset (n = 2627; with 10 control children missing probably due to the matching procedure). RESULTS Immigrant children had a higher median glycated haemoglobin level (HbA1c) than their Swedish peers, but there was no difference in the frequency of hypoglycaemia or ketoacidosis between the two cohorts. A linear regression model with HbA1c as a dependent variable showed that insulin units per kilogram of body weight were the main reason for inferior metabolic control. CONCLUSION Children with type 1 diabetes born to immigrant parents had inferior metabolic control three years after disease onset compared to children with Swedish born parents. Social family support and educational coping programmes are needed to improve treatment outcomes in immigrants with diabetes.
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Affiliation(s)
- Ulf Söderström
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
- Centre for Clinical Research Sörmland; Uppsala University; Uppsala Sweden
- Department of Pediatrics; Mälarsjukhuset Hospital; Eskilstuna Sweden
| | - Ulf Samuelsson
- Division of Paediatrics; Department of Molecular and Clinical Medicine; Linkoping University; Linköping Sweden
- Department of Pediatrics; The University Hospital in Linköping; Linköping Sweden
| | - Jan Åman
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
- Department of Pediatrics; Örebro University Hospital; Örebro Sweden
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16
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Anderzén J, Samuelsson U, Gudbjörnsdottir S, Hanberger L, Åkesson K. Teenagers with poor metabolic control already have a higher risk of microvascular complications as young adults. J Diabetes Complications 2016; 30:533-6. [PMID: 26775554 DOI: 10.1016/j.jdiacomp.2015.12.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/23/2015] [Accepted: 12/03/2015] [Indexed: 01/28/2023]
Abstract
AIMS To evaluate how HbA1c in adolescents with type 1 diabetes affects microvascular complications in young adults. METHODS All individuals registered in the Swedish paediatric diabetes quality registry (SWEDIABKIDS) 13-18 years of age, and as adults registered in the Swedish National Diabetes Registry (NDR) in both the years 2011 and 2012 were included, in total 4250 individuals. RESULTS Of the individuals with mean HbA1c >78 mmol/mol in SWEDIABKIDS 83.4% had retinopathy, 15.8% had microalbuminuria and 4.9% had macroalbuminuria in NDR. The logistic regression analysis showed that the OR to develop macroalbuminuria as a young adult was significantly higher in the group with mean HbA1c >78 mmol/mol in SWEDIABKIDS (p<0.05). Among the patients with mean HbA1c above 78 mmol/mol in both registries there was a significantly higher proportion that had retinopathy, microalbuminuria (p<0.001) and/or macroalbuminuria (p<0.01) compared to the group with HbA1c below 57 mmol/mol in both registries. Only 6.5% of the persons in this study were over 30 years of age. CONCLUSIONS Paediatric diabetes teams working with teenagers must be aware of the impact of good metabolic control during adolescence, and should intensify the care during this vulnerable period of life to reduce the risk of microvascular complications in young adults.
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Affiliation(s)
- Johan Anderzén
- Department of Paediatrics, Ryhov County Hospital, Jönköping Sweden.
| | - Ulf Samuelsson
- Department of Clinical and Experimental Medicine, Division of Paediatrics and Diabetes. Research Centre, Linköping University Hospital, Linköping, Sweden
| | - Soffia Gudbjörnsdottir
- Department of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Hanberger
- Department of Medical and Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden
| | - Karin Åkesson
- Department of Paediatrics, Ryhov County Hospital, Jönköping Sweden; Futurum, Jönköping County Council and Jönköping Academy for improvement of health and welfare
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17
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Åkesson K, Hanberger L, Samuelsson U. The influence of age, gender, insulin dose, BMI, and blood pressure on metabolic control in young patients with type 1 diabetes. Pediatr Diabetes 2015; 16:581-6. [PMID: 25270077 DOI: 10.1111/pedi.12219] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 08/17/2014] [Accepted: 08/29/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore the relationship between certain clinical variables and metabolic HbA1c at diagnosis correlated to HbA1c at follow-up (p < 0.001). There was a clear gender difference regarding HbA1c. Girls had higher values both at diagnosis and at follow-up (p < 0.001). Girls also had lower BMI and pH at diagnosis than boys (p < 0.001). In contrast, girls with the highest body mass index (BMI) at follow-up had higher mean HbA1c at follow-up in 2010 (p < 0.001). Having a mother and/or a father with high BMI implied higher HbA1c at diagnosis (p < 0.003). CONCLUSIONS HbA1c at diagnosis seems to predict metabolic control years later. There is a gender difference at diagnosis as female patients have higher HbA1c than males at diagnosis as well as at follow up. As metabolic control is very much correlated to complications there is a need to early identify patients at risk of poor metabolic control. Even though we do not know whether a high HbA1c level is mainly due to severity of the disease or to behavioral patterns, new ways to treat and support these children, especially girls, are needed.
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Affiliation(s)
- Karin Åkesson
- Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden.,Futurum - Academy for Health and Care, Jönköping County Council and Jönköping Academy for improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Lena Hanberger
- Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes. Research Center, Linköping University Hospital, Linköping, Sweden
| | - Ulf Samuelsson
- Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes. Research Center, Linköping University Hospital, Linköping, Sweden
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18
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Söderström U, Samuelsson U, Sahlqvist L, Åman J. Impaired metabolic control and socio-demographic status in immigrant children at onset of Type 1 diabetes. Diabet Med 2014; 31:1418-23. [PMID: 24861156 DOI: 10.1111/dme.12511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 03/04/2014] [Accepted: 05/22/2014] [Indexed: 11/26/2022]
Abstract
AIM The aim of the present study was to compare clinical and socio-demographic conditions at the onset of Type 1 diabetes in children born to immigrant families and children born to Swedish families, and to assess whether those conditions had an impact on metabolic status. METHODS AND DESIGN This was an observational nationwide population-based matched cohort study on prospectively recorded registry data of all children with diabetes in Sweden and their families during 2000-2010. Out of a total of 13 415 children from the Swedish Childhood Diabetes Registry (SWEDIABKIDS), 879 children born to immigrant parents were collected. To these we added 2627 children with Swedish-born parents, matched for gender, age and year of onset of Type 1 diabetes. RESULTS The proportion of low capillary pH (< 7.30) at onset was higher in the immigrant cohort [25.8% vs. 16.4% in the Swedish cohort (P < 0.001)]. HbA1c was also higher [95 mmol/mol (10.8%) vs. 88 mmol/mol (10.2%), respectively (P < 0.001)]. In a logistic regression model with low pH as the dependent variable, we were unable to reveal any significant association to socio-demographic factors, but the odds ratio for HbA1c was 0.983 (95% CI 0.976-0.991) and for plasma glucose was 0.953 (95% CI 0.933-0.973). CONCLUSION Children born to immigrant parents have lower capillary pH and higher HbA1c at diabetes onset. Immigrant families harbour lower socio-demographic living conditions, but this fact does not seem to influence the inferior metabolic condition at diabetes onset.
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Affiliation(s)
- U Söderström
- School of Health and Medical Sciences Örebro University, Örebro; Centre for Clinical Research Sörmland, Uppsala University, Uppsala; Department of Pediatrics, Mälarsjukhuset Hospital, Eskilstuna
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19
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Peterson A, Hanberger L, Åkesson K, Bojestig M, Andersson Gäre B, Samuelsson U. Improved results in paediatric diabetes care using a quality registry in an improvement collaborative: a case study in Sweden. PLoS One 2014; 9:e97875. [PMID: 24867418 PMCID: PMC4035257 DOI: 10.1371/journal.pone.0097875] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 04/24/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Several studies show that good metabolic control is important for children and adolescents with type 1 diabetes. In Sweden, there are large differences in mean haemoglobin A1c (HbA1c) in different hospitals and difficulties implementing national guidelines in everyday practice. This study shows how the participation in an improvement collaborative could facilitate improvements in the quality of care by paediatric diabetes teams. The Swedish paediatric diabetes quality registry, SWEDIABKIDS was used as a tool and resource for feedback and outcome measures. METHODS Twelve teams at paediatric diabetes centres, caring for 30% (2302/7660) of patients in Sweden, participated in an 18-month quality improvement program. Each team defined treatment targets, areas needing improvement, and action plans. The main outcome was the centre patients' mean HbA1c levels, but other clinical variables and change concepts were also studied. Data from the previous six months were compared with the first six months after starting the program, and the long-term follow up after another eleven months. RESULTS All centres reduced mean HbA1c during the second and third periods compared with the first. The mean reduction for all was 3·7 mmol/mol (p<0.001), compared with non-participating centres who improved their mean HbA1c with 1·7 mmol/mol during the same period. Many of the participating centres reduced the frequency of severe hypoglycaemia and/or ketoacidosis, and five centres reached their goal of ensuring that all patients had some sort of physical activity at least once weekly. Change concepts were, for example, improved guidelines, appointment planning, informing the patients, improving teamwork and active use of the registry, and health promotion activities. CONCLUSIONS By involving paediatric diabetes teams in a quality improvement collaborative together with access to a quality register, the quality of paediatric diabetes care can improve, thereby contributing to a reduced risk of late complications for children and adolescents with diabetes.
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Affiliation(s)
- Anette Peterson
- Jönköping University, School of Health Science, the Jönköping Academy for Improvement of Health and Welfare and Jönköping County Council, Jönköping, Sweden
| | - Lena Hanberger
- Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes. Research Center, Linköping University Hospital, Linköping, Sweden
- Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Karin Åkesson
- Department of Pediatric, County Hospital Ryhov, Jönköping, Sweden
- Jönköping University, School of Health Science, the Jönköping Academy for Improvement of Health and Welfare and Jönköping County Council, Jönköping, Sweden
| | - Mats Bojestig
- Jönköping University, School of Health Science, the Jönköping Academy for Improvement of Health and Welfare and Jönköping County Council, Jönköping, Sweden
| | - Boel Andersson Gäre
- Jönköping University, School of Health Science, the Jönköping Academy for Improvement of Health and Welfare and Jönköping County Council, Jönköping, Sweden
| | - Ulf Samuelsson
- Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes. Research Center, Linköping University Hospital, Linköping, Sweden
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20
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Psychological Support for Children with Diabetes: Are the Guidelines Being Met? J Clin Psychol Med Settings 2014; 21:190-9. [DOI: 10.1007/s10880-014-9395-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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21
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Samuelsson U, Steineck I, Gubbjornsdottir S. A high mean-HbA1c value 3-15 months after diagnosis of type 1 diabetes in childhood is related to metabolic control, macroalbuminuria, and retinopathy in early adulthood--a pilot study using two nation-wide population based quality registries. Pediatr Diabetes 2014; 15:229-35. [PMID: 24119008 DOI: 10.1111/pedi.12085] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 08/13/2013] [Accepted: 08/28/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Intensive treatment of patients with type 1 diabetes delays the onset of long-term complications. OBJECTIVES On the basis of the information from two nation-wide quality registers, we investigated to which extent HbA1c values 3-15 months after diagnosis in childhood are related to metabolic control, albuminuria, and retinopathy in early adulthood. METHODS In Sweden, physicians register all children and adolescents with type 1 diabetes mellitus in the Swedish Pediatric Quality Registry. After 18 yr of age, people with diabetes are followed by the Swedish National Diabetes Register. We identified 1543 children and adolescents with a mean age of 13.9 yr at diagnosis and a mean duration of type 1 diabetes mellitus of 7.1 yr. RESULTS Children and adolescents with poor metabolic control (mean HbA1c ≥ 70 mmol/mol (8.6 %)) adjacent to diagnosis had a significantly higher mean HbA1c value years later as adults than did patients with a good metabolic control [<50 mmol/mol (6.7%) (p < 0.001)]. The patients in the high group were also less physically active and smoked more as adults. The proportion of females was higher in the poor metabolic group. Patients with a high mean HbA1c 3-15 months after diagnosis had significantly more often macroalbuminuria and retinopathy in early adulthood. CONCLUSIONS Metabolic control adjacent to the diagnosis of type 1 diabetes in childhood or adolescence can predict metabolic control in early adulthood. It is therefore very important that pediatric diabetes teams identify key factors for successful early metabolic control. Actively using quality registries may be one such factor.
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Affiliation(s)
- Ulf Samuelsson
- Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes Research Center, Linköping University Hospital, Linköping, Sweden
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Carlsson A, Forsander G, Ludvigsson J, Larsen S, Örtqvist E. A multicenter observational safety study in Swedish children and adolescents using insulin detemir for the treatment of type 1 diabetes. Pediatr Diabetes 2013; 14:358-65. [PMID: 23448369 PMCID: PMC3810710 DOI: 10.1111/pedi.12019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 11/16/2012] [Accepted: 12/19/2012] [Indexed: 11/29/2022] Open
Abstract
This 26-wk observational study in children and adolescents with type 1 diabetes (T1D) in Sweden investigated the safety and efficacy of insulin detemir (IDet) in newly diagnosed (ND) patients and those with established diabetes (ED) switching to IDet. A total of 159 patients initiated IDet as part of basal-bolus therapy, 59 in the ND stratum (mean age 9.7 yr) and 97 in the ED stratum (mean age 12.5 yr). The primary outcome measure was the incidence of severe adverse drug reactions; just one major hypoglycemic event occurred in a patient in the ND stratum during the study and one patient was withdrawn due to injection-site reactions. All other events were classified as mild. In the ED stratum, there was a reduction in hypoglycemic events in the 4 wk prior to study end from baseline (mean reduction of 2.46 events, not significant) and a significant reduction in nocturnal hypoglycemia (mean reduction of 2.24 events, p = 0.0078). Glycemic control improved in the ND stratum as expected and, in the ED stratum, there was no significant change in HbA1c from baseline (mean reduction of -0.45%). At study end, mean daily IDet doses were 0.39 U/kg (ND) and 0.54 U/kg (ED). Weight increased by 5.7 and 2.0 kg in the ND and ED strata, respectively, and was within the normal limits for growing children. IDet provided good glycemic control and was well tolerated, with a reduced risk of nocturnal hypoglycemia in a heterogeneous cohort of children and adolescents with T1D.
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Affiliation(s)
- Annelie Carlsson
- Department of Clinical Sciences, SUS University Hospital, Lund University, Lund, Sweden.
| | - Gun Forsander
- Department of Pediatrics, The Queen Silvia Children’s Hospital, Sahlgrenska University HospitalGöteborg, Sweden
| | - Johnny Ludvigsson
- Divison of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University and Östergötland County CouncilLinköping, Sweden
| | | | - Eva Örtqvist
- Division of Pediatrics, Astrid Lindgrens Children’s Hospital, Karolinska University HospitalStockholm, Sweden
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Danne T, Aschemeier B, Perfetti R. SWEET--where are we heading with international type 1 diabetes registries? Pediatr Diabetes 2012; 13 Suppl 16:1-4. [PMID: 22931218 DOI: 10.1111/j.1399-5448.2012.00906.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Thomas Danne
- Children's Hospital AUF DER BULT; D-30173; Hannover; Germany
| | | | - Riccardo Perfetti
- Global Medical Affairs; Sanofi, Diabetes Division; 75008; Paris; France
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