Continuing stability of center differences in pediatric diabetes care: Do advances in diabetes treatment improve outcome? The Hvidoere study group on childhood diabetes

Carine E. De Beaufort; Peter G.F. Swift; Chas T. Skinner; Henk J. Aanstoot; Jan Åman; Fergus Cameron; Pedro Martul; Francesco Chiarelli; Dennis Daneman; Thomas Danne; Harry Dorchy; Hilary Hoey; Eero A. Kaprio; Francine Kaufman; Mirjana Kocova; Henrik B. Mortensen; Pal R. Njølstad; Moshe Phillip; Kenneth J. Robertson; Eugen J. Schoenle; Tatsuhiko Urakami; Maurizio Vanelli

doi:10.2337/dc07-0475

Continuing stability of center differences in pediatric diabetes care: Do advances in diabetes treatment improve outcome? The Hvidoere study group on childhood diabetes

Carine E. De Beaufort^*, Peter G.F. Swift, Chas T. Skinner, Henk J. Aanstoot, Jan Åman, Fergus Cameron, Pedro Martul, Francesco Chiarelli, Dennis Daneman, Thomas Danne, Harry Dorchy, Hilary Hoey, Eero A. Kaprio, Francine Kaufman, Mirjana Kocova, Henrik B. Mortensen, Pal R. Njølstad, Moshe Phillip, Kenneth J. Robertson, Eugen J. SchoenleTatsuhiko Urakami, Maurizio Vanelli

^*Corresponding author for this work

172 Citations (Scopus)

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.

Original language	English
Journal	Diabetes Care
Volume	30
Issue number	9
Pages (from-to)	2245-2250
Number of pages	6
ISSN	0149-5992
DOIs	https://doi.org/10.2337/dc07-0475
Publication status	Published - 1 Sept 2007

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De Beaufort, C. E., Swift, P. G. F., Skinner, C. T., Aanstoot, H. J., Åman, J., Cameron, F., Martul, P., Chiarelli, F., Daneman, D., Danne, T., Dorchy, H., Hoey, H., Kaprio, E. A., Kaufman, F., Kocova, M., Mortensen, H. B., Njølstad, P. R., Phillip, M., Robertson, K. J., ... Vanelli, M. (2007). Continuing stability of center differences in pediatric diabetes care: Do advances in diabetes treatment improve outcome? The Hvidoere study group on childhood diabetes. Diabetes Care, 30(9), 2245-2250. https://doi.org/10.2337/dc07-0475

Continuing stability of center differences in pediatric diabetes care : Do advances in diabetes treatment improve outcome? The Hvidoere study group on childhood diabetes. / De Beaufort, Carine E.; Swift, Peter G.F.; Skinner, Chas T. et al.

In: Diabetes Care, Vol. 30, No. 9, 01.09.2007, p. 2245-2250.

Research output: Contribution to journal › Journal article › Research › peer-review

De Beaufort, CE, Swift, PGF, Skinner, CT, Aanstoot, HJ, Åman, J, Cameron, F, Martul, P, Chiarelli, F, Daneman, D, Danne, T, Dorchy, H, Hoey, H, Kaprio, EA, Kaufman, F, Kocova, M, Mortensen, HB, Njølstad, PR, Phillip, M, Robertson, KJ, Schoenle, EJ, Urakami, T & Vanelli, M 2007, 'Continuing stability of center differences in pediatric diabetes care: Do advances in diabetes treatment improve outcome? The Hvidoere study group on childhood diabetes', Diabetes Care, vol. 30, no. 9, pp. 2245-2250. https://doi.org/10.2337/dc07-0475

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title = "Continuing stability of center differences in pediatric diabetes care: Do advances in diabetes treatment improve outcome? The Hvidoere study group on childhood diabetes",

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.",

author = "{De Beaufort}, {Carine E.} and Swift, {Peter G.F.} and Skinner, {Chas T.} and Aanstoot, {Henk J.} and Jan {\AA}man and Fergus Cameron and Pedro Martul and Francesco Chiarelli and Dennis Daneman and Thomas Danne and Harry Dorchy and Hilary Hoey and Kaprio, {Eero A.} and Francine Kaufman and Mirjana Kocova and Mortensen, {Henrik B.} and Nj{\o}lstad, {Pal R.} and Moshe Phillip and Robertson, {Kenneth J.} and Schoenle, {Eugen J.} and Tatsuhiko Urakami and Maurizio Vanelli",

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T1 - Continuing stability of center differences in pediatric diabetes care

T2 - Do advances in diabetes treatment improve outcome? The Hvidoere study group on childhood diabetes

AU - De Beaufort, Carine E.

AU - Swift, Peter G.F.

AU - Skinner, Chas T.

AU - Aanstoot, Henk J.

AU - Åman, Jan

AU - Cameron, Fergus

AU - Martul, Pedro

AU - Chiarelli, Francesco

AU - Daneman, Dennis

AU - Danne, Thomas

AU - Dorchy, Harry

AU - Hoey, Hilary

AU - Kaprio, Eero A.

AU - Kaufman, Francine

AU - Kocova, Mirjana

AU - Mortensen, Henrik B.

AU - Njølstad, Pal R.

AU - Phillip, Moshe

AU - Robertson, Kenneth J.

AU - Schoenle, Eugen J.

AU - Urakami, Tatsuhiko

AU - Vanelli, Maurizio

PY - 2007/9/1

Y1 - 2007/9/1

N2 - 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.

AB - 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.

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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

Abstract

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