Among young patients with type 1 diabetes, insulin pump therapy, compared with insulin injection therapy, was associated with lower risks of severe hypoglycemia and diabetic ketoacidosis and with better glycemic control during the most recent year of therapy. These findings provide evidence for improved clinical outcomes associated with insulin pump therapy compared with injection therapy in children, adolescents, and young adults with type 1 diabetes.

Using a trajectory approach, we determined five distinct longitudinal patterns of glycemic control from childhood to early adulthood. Diabetes self-care, treatment differences, and demographics were related to different HbA courses.

Background Intensified insulin delivery using multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) is recommended in children with type 1 diabetes (T1D) to achieve good metabolic control. Objective To examine the frequency of pump usage in T1D children treated in SWEET (Better control in Paediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) centers and to compare metabolic control between patients treated with CSII vs MDI. Methods This study included 16 570 T1D children participating in the SWEET prospective, multicenter, standardized diabetes patient registry. Datasets were aggregated over the most recent year of treatment for each patient. Data were collected until March 2016. To assess the organization of pump therapy a survey was carried out. Results Overall, 44.4% of T1D children were treated with CSII. The proportion of patients with pump usage varied between centers and decreased with increasing age compared with children treated with MDI. In a logistic regression analysis adjusting for age, gender and diabetes duration, the use of pump was associated with both: center size [odd ratio 1.51 (1.47‐1.55), P < .0001) and the diabetes‐related expenditure per capita [odd ratio 1.55 (1.49‐1.61), P < .0001]. Linear regression analysis, adjusted for age, gender, and diabetes duration showed that both HbA1c and daily insulin dose (U/kg/d) remained decreased in children treated with CSII compared to MDI (P < .0001). Conclusions Insulin pump therapy is offered by most Sweet centers. The differences between centers affect the frequency of use of modern technology. Despite the heterogeneity of centers, T1D children achieve relatively good metabolic control, especially those treated with insulin pumps and those of younger age.

In this large diabetic cohort, smallest bias and highest accuracy were observed for the MDRD.

Our vision is that the participation in SWEET is encouraging members to deliver increasingly accurate and complete data. Dissemination of results and prospective projects serve as further motivation to improve data reporting. Comparing processes and outcomes will help members identify weaknesses and introduce innovative solutions, resulting in improved and more uniform care for patients with diabetes.

The high rate of OW and obesity (31.8%) emphasize the need for developing further strategies to prevent and treat excess fat accumulation in T1D.

An essential feature of standardization of measurement is that it allows for detection and learning from variation present in a health care system. Standardized documentation has the advantage to improve patient care due to better exchange of information among members of a medical team and, in addition allows both, internal and external quality control. This article addresses the latter aspect, based on 20 years of experience from the Austrian/German quality initiative DPV.The aspect of quality of medical care has somewhat different challenges in chronic diseases, as opposed to acute medical disorders. For acute problems, QC (quality control) will focus on the question whether the problem has been solved to the complete satisfaction of patients, whether side effects did occur, for example infection or postsurgery bleeding following a surgical procedure, and what the costs arise for the patient (length of hospitalization, pain, number of control exams, direct financial burden for the patient) as well as for society (time not at work) or reimbursement companies. These aspects are often quite easy to cover with a limited number of items.1 In contrast, the nature of chronic disorders provides specific challenges that have to be addressed when standardized documentation for chronic disorders like diabetes are implemented. 3 The St. Vincent declaration identified 5 major goals to be achieved during the next 5 years (Table 1). 4 The use of standardized documentation and information technology together with the application of quality control techniques developed previously in automobile manufacturing especially in Japan were listed among other tools to improve diabetes care. A specific data set and a documentation tool were developed in Europe (DiabCare or QUALIDIAB), with modifications for children. The St. Vincent initiative has had long-lasting effects on the public health aspects of diabetology 5 and has been adopted to other regions of the world like the "Declaration of the Americas" 6

The SWEET project 10-year benchmarking in 19 countries worldwide is associated with improved HbA1c and increased use of diabetes technology in youth with type 1 diabetes.