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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

  1. Carine E. de Beaufort, MD, PHD1,
  2. Peter G.F. Swift, MD2,
  3. Chas T. Skinner, PHD3,
  4. Henk J. Aanstoot, MD, PHD4,
  5. Jan Åman, MD5,
  6. Fergus Cameron, MD6,
  7. Pedro Martul, MD7,
  8. Francesco Chiarelli, MD8,
  9. Dennis Daneman, MD9,
  10. Thomas Danne, MD10,
  11. Harry Dorchy, MD, PHD11,
  12. Hilary Hoey, MD12,
  13. Eero A. Kaprio, MD13,
  14. Francine Kaufman, MD14,
  15. Mirjana Kocova, MD, PHD15,
  16. Henrik B. Mortensen, MD16,
  17. Pal R. Njølstad, MD, PHD17,
  18. Moshe Phillip, MD18,
  19. Kenneth J. Robertson, MD19,
  20. Eugen J. Schoenle, MD20,
  21. Tatsuhiko Urakami, MD21,
  22. Maurizio Vanelli, MD22 and
  23. on behalf of the Hvidoere Study Group on Childhood Diabetes 2005
  1. 1DECCP, Clinique Pédiatrique/Centre Hospitalier, Luxembourg
  2. 2Department of Paediatrics, Leicester Royal Infirmary Children's Hospital Leicester, U.K
  3. 3Department of Psychology, University of Wollongong, Wollongong, Australia
  4. 4Diabetes, Center for Pediatric and Adolescent Diabetes, Rotterdam, the Netherlands
  5. 5Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
  6. 6Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia
  7. 7Endocrinology and Diabetes Research Group, Hospital de Cruces, Cruces, Spain
  8. 8Department of Pediatrics, University of Chieti, Chieti, Italy
  9. 9Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
  10. 10Kinderkrankenhaus auf der Bult, Hannover, Germany
  11. 11Diabetology Clinic, Children's University Hospital Queen Fabiola, Brussels, Belgium
  12. 12Department of Paediatrics, Trinity College, National Childrens Hospital, Dublin, Ireland
  13. 13Department of Paediatrics, Peijas Hospital, Vantaa, Finland
  14. 14Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles California
  15. 15Pediatric Clinic, Medical Faculty Department of Endocrinology and Genetics, Skopje, Republic of Macedonia
  16. 16Paediatric Department L, Glostrup University Hospital, Glostrup, Denmark
  17. 17Department of Pediatrics, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
  18. 18National Center of Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
  19. 19Department of Paediatrics, Royal Hospital for Sick Children, Glasgow, Scotland
  20. 20Department of Paediatrics, University Childrens Hospital, Zurich, Switzerland
  21. 21Department of Paediatrics, Nihon University School of Medicine, Tokyo, Japan
  22. 22Centro di Diabetologia, University of Parma, Parma, Italy
  1. Address correspondence and reprint requests to Dr. Carine de Beaufort, Clinique Pédiatrique, Centre Hospitalier de Luxembourg, 4, rue Barblé, 1220 Luxembourg. E-mail: debeaufort.carine{at}chl.lu

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.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 31 May 2007. DOI: 10.2337/dc07-0475.

    C.E.B. has received travel grant support and speaking honoraria from Medtronic and Roche. F.Ca. has received research funding support, travel support, and honoraria from Medtronic, Eli Lilly, Aventis, and Animas. K.J.R. has received travel expenses and speaking fees from NovoNordisk.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted May 24, 2007.
    • Received March 24, 2007.
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This Article

  1. Published online before print May 31, 2007, doi: 10.2337/dc07-0475 Diabetes Care vol. 30 no. 9 2245-2250
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