Glycemic control in children with Type 1 diabetes in Wales: the influence of the Pediatric Diabetes Specialist Nurse

  1. John N Harvey, MD, FRCP (john.harvey{at}wales.nhs.uk)2
  1. From the 1Department of Pediatrics, Bro Morgannwg NHS Trust, Swansea, UK; and
  2. the 2Centre for Endocrinology & Diabetes Sciences, Wales College of Medicine, Cardiff University, Cardiff, UK

Abstract

Objective – To determine if glycemic control is improving in diabetic children in Wales; to identify factors associated with improvement.

Research design and methods– Data collected in 2001 and 2006.

Results – Over time HbA1c reduced from 9.08±1.66 to 8.88±1.63% (p=0.012). There were differences between centers (p<0.001) and differential change over time (interaction p<0.001). Since 2001 five centres had appointed a pediatric diabetes specialist nurse (PDSN). These centres improved HbA1c from 9.59±1.88 to 8.72±1.61% (p<0.001). Glycemic control was worse in children aged >10y compared to younger patients (p<0.001). Improvement occurred in those aged >10y. Age (p=0.003) and insulin dose (p<0.001) were positively and independently associated with HbA1c. Thus any influence of PDSNs was not achieved through increased insulin prescription.

Conclusions – Improvement in glycemic control has occurred. Worse control is seen associated with greater prescribed insulin dose in older children. Appointing PDSNs was associated with improved glycemic control amongst adolescents.

Footnotes

  • Received December 17, 2009.
  • Accepted April 27, 2010.

This Article

  1. Diabetes Care
  1. All Versions of this Article:
    1. dc09-2304v1
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