Continuing Stability of Center Differences in Pediatric Diabetes Care: Do Advances in Diabetes Treatment Improve Outcome?

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. RESULTS -Mean A1C was 8.2 Ϯ 1.4%, with substantial variation between centers (mean A1C range 7.4 -9.2%; P Ͻ 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 Ϯ 2.0% vs. 8.2 Ϯ 1.4% for those with language difficulties vs. those without, respectively; P Ͻ 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. RESEARCH DESIGN AND METHODSCONCLUSIONS -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.

Dietary Behaviors Predict Glycemic Control in Youth With Type 1 Diabetes

“…ata for youth with type 1 diabetes demonstrate a gap between attained glycemic control and age-specific goals (1)(2)(3). With intensive insulin therapy, dietary behaviors become central to optimizing glycemic control.…”

Evaluating the Accuracy and Large Inaccuracy of Two Continuous Glucose Monitoring Systems

“…Maintaining good glycemic control while avoiding hypoglycemia remains an intangible goal for many subjects with type 1 diabetes despite progress in therapeutic options such as insulin pump therapy and continuous glucose monitoring (CGM). 1,2 Novel approaches are needed before cure in the form of cell-based therapy or immunotherapy becomes available.…”

5thAnnual Symposium on Self-Monitoring of Blood Glucose (SMBG) Applications and Beyond, May 3–5, 2012, Dublin, Ireland

“…Moshe Phillip began his lecture with an introduction about the current status of treating pediatric patients with MDI. Currently, despite the fact that new analogs and different kinds of insulin are available, the ''pediatric definition of the target of HbA1c below 7.5 according to ISPAD [International Society for Pediatric and Adolescent Diabetes]'' guidelines has widely not been achieved yet, stated Phillip, as shown by HbA1c results from 21 centers of excellence, the Hvidøre study group, 28 a Scottish survey of 24,750 people with T1D, 29 and an Australian survey. 30 Phillip said, ''Most of the patients are treated by the MDI approach associated with swings in glucose level, changing from hyper-to hypoglycemia during the day, some unpredicted hypoglycemia, and some uncontrolled hyperglycemia.…”