Persistent Differences Among Centers Over 3 Years in Glycemic Control and Hypoglycemia in a Study of 3,805 Children and Adolescents With Type 1 Diabetes From the Hvidøre Study Group
2001; American Diabetes Association; Volume: 24; Issue: 8 Linguagem: Inglês
10.2337/diacare.24.8.1342
ISSN1935-5548
AutoresThomas Danne, Henrik B. Mortensen, Philip Hougaard, Helle Lynggaard, Henk‐Jan Aanstoot, Francesco Chiarelli, Denis Daneman, Harry Dorchy, P Garandeau, Stephen Greene, Hilary Hoey, Reinhard W. Holl, Jaakko Kaprio, Mirjana Kočova, P. Martul, Nobuo Matsuura, Kenneth Robertson, Eugen J. Schoenle, Oddmund Søvik, Peter G.F. Swift, Rosa Maria Tsou, Maurizio Vanelli, Jan Åman,
Tópico(s)Diabetes and associated disorders
ResumoOBJECTIVE—Twenty-one international pediatric diabetes centers from 17 countries investigated the effect of simple feedback about the grand mean HbA1c level of all centers and the average value of each center on changes in metabolic control, rate of severe hypoglycemia, and insulin therapy over a 3-year period. RESEARCH DESIGN AND METHODS—Clinical data collection and determination of HbA1c levels were conducted at a central location in 1995 (n = 2,780, age 0–18 years) and 1998 (n = 2,101, age 11–18 years). RESULTS—Striking differences in average HbA1c concentrations were found among centers; these differences remained after adjustment for the significant confounders of sex, age, and diabetes duration. They were apparent even in patients with short diabetes duration and remained stable 3 years later (mean adjusted HbA1c level: 8.62 ± 0.03 vs. 8.67 ± 0.04 [1995 vs. 1998, respectively]). Three centers had improved significantly, four centers had deteriorated significantly in their overall adjusted HbA1c levels, and 14 centers had not changed in glycemic control. During the observation period, there were increases in the adjusted insulin dose by 0.076 U/kg, the adjusted number of injections by 0.23 injections per day, and the adjusted BMI by 0.95 kg/m2. The 1995 versus 1998 difference in glycemic control for the seven centers could not be explained by prevailing insulin regimens or rates of hypoglycemia. CONCLUSIONS—This study reveals significant outcome differences among large international pediatric diabetes centers. Feedback and comparison of HbA1c levels led to an intensification of insulin therapy in most centers, but improved glycemic control in only a few.
Referência(s)