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

• Published in: Diabetes care Vol. 24; no. 8; pp. 1342 - 1347
• Main Authors: DANNE, Thomas, MORTENSEN, Henrik B, HOEY, Hilary, HOLL, Reinhard W, KAPRIO, Eero A, KOCOVA, Mirjana, MARTUL, Pedro, MATSUURA, Nobuo, ROBERTSON, Kenneth J, SCHOFNLE, Eugen J, SØVIK, Oddmund, SWIFT, Peter G. F, HOUGAARD, Philip, TSOU, Rosa M, VANELLI, Maurizio, AMAN, Jan, LYNGGAARD, Helle, AANSTOOT, Henk-Jan, CHIARELLI, Francesco, DANEMAN, Denis, DORCHY, Harry, GARANDEAU, Patrick, GREENE, Stephen A
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.08.2001
• Subjects: Adolescent; Biological and medical sciences; Biomarkers - blood; Blood Glucose - metabolism; Child; Comparative analysis; Cross-Sectional Studies; Diabetes; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - drug therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Europe; Female; Glycated Hemoglobin A - analysis; Humans; Hypoglycemia; Hypoglycemia - epidemiology; Hypoglycemia - prevention & control; Incidence; Insulin; Insulin - adverse effects; Insulin - therapeutic use; International; Japan; Male; Management. Various non-drug treatments. Langerhans islet grafts; Medical sciences; North America; Pediatrics; Reproducibility of Results; Endocrinopathy; Human; Immunopathology; Autoimmune disease; Hypoglycemia; Prevention; Surveillance; Hemoglobin A1c; Adolescent; Clinical biology; Insulin dependent diabetes; Complication; Child; Glycemia
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.24.8.1342

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 Thomas Danne , MD 1 , Henrik B. Mortensen , DR MED SCI 2 , Philip Hougaard , PHD, DSC 3 , Helle Lynggaard , MSC 3 , Henk-Jan Aanstoot , MD, PHD 4 , Francesco Chiarelli , MD 5 , Denis Daneman , MB BCH, FRCPC 6 , Harry Dorchy , MD, PHD 7 , Patrick Garandeau , MD 8 , Stephen A. Greene , MD 9 , Hilary Hoey , MD, FRCPI 10 , Reinhard W. Holl , MD 11 , Eero A. Kaprio , MD 12 , Mirjana Kocova , MD, PHD 13 , Pedro Martul , MD, PHD 14 , Nobuo Matsuura , MD, PHD 15 , Kenneth J. Robertson , MD 16 , Eugen J. Schoenle , MD, PHD 17 , Oddmund Søvik , MD 18 , Peter G.F. Swift , MD, FRCP 19 , Rosa M. Tsou , MD 20 , Maurizio Vanelli , MD 21 , Jan Åman , MD, PHD 22 and for the Hvidøre Study Group on Childhood Diabetes 1 Charité Children’s Hospital, Humboldt University, Berlin, Germany 2 Department of Pediatrics, Glostrup University Hospital, Glostrup, Denmark 3 Department of Statistics, Novo Nordisk A/S, Bagsvaerd, Denmark 4 Sophia Children’s Hospital, Rotterdam, the Netherlands 5 Pediatric University Clinic, Chieti, Italy 6 The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada 7 University Children’s Hospital “Reine Fabiola,” Brussels, Belgium 8 Institut St. Pierre, Montpellier, France 9 Ninewells Hospital, Dundee, U.K. 10 University of Dublin, National Children’s Hospital, Tallaght, Ireland 11 Ulm University, Ulm, Germany 12 Department of Pediatrics, Peijas Hospital, Vantaa, Finland 13 University Pediatric Clinic, Skopje, Republic of Macedonia 14 Hospital de Cruces, Baracaldo, Spain 15 Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan 16 Royal Hospital for Sick Children, Glasgow, U.K. 17 University Children’s Hospital, Zurich, Switzerland 18 Department of Pediatrics, Haukeland Hospital, Bergen, Norway 19 Leicester Royal Infirmary Children’s Hospital, Leicester, U.K. 20 Pediatric Department, Hospital S. João, Porto, Portugal 21 Pediatric Clinic of Parma University, Parma, Italy 22 Örebro Regional Hospital, Örebro, Sweden Abstract OBJECTIVE —Twenty-one international pediatric diabetes centers from 17 countries investigated the effect of simple feedback about the grand mean HbA 1c 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 HbA 1c 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 HbA 1c 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 HbA 1c 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 HbA 1c 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/m 2 . 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 HbA 1c levels led to an intensification of insulin therapy in most centers, but improved glycemic control in only a few. Footnotes Address correspondence and reprint requests to Dr. Thomas Danne, Diabetes-Zentrum für Kinder- und Jugendliche, Kinderkrankenhaus auf der Bult, Janusz-Korczak-Allee 12, 30173 Hannover, Germany. E-mail: danne{at}hka.de . Received for publication 28 September 2000 and accepted in revised form 17 April 2001. R.W.H. has received a grant and other funds from Novo Nordisk; K.J.R. has received funds for research from Novo Nordisk; and P.H. and H.L. hold stock in Novo Nordisk. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.