Targets and teamwork: Understanding differences in pediatric diabetes centers treatment outcomes

Skinner, Timothy; Lange, Karin; Hoey, Hilary; Mortensen, Henrik B.; Aanstoot, Henk‐Jan; Castaño, Luís; Skovlund, Søren E.; Swift, Peter; Cameron, Fergus; Dorchy, Harry; Palmert, Mark R.; Kaprio, Eero A.; Robert, Jean‐Jacques; Danne, Thomas; Neu, Andreas; Shalitin, Shlomit; Chiarelli, Francesco; Chiari, G; Urakami, Tatsuhiko; Njølstad, Pål R.; Jarosz-Chobot, Przemysława; Roche, Edna; Castro-Correia, Cíntia; Kočova, Mirjana; Åman, Jan; Schönle, Eugen; Barrett, Timothy; Fisher, Lynda K.; Beaufort, Carine de

doi:10.1111/pedi.12606

Cited by 19 publications

(18 citation statements)

References 13 publications

(40 reference statements)

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“…A role model for such activities is the Swedish model of open benchmarking in paediatric diabetology. The Swedish paediatric diabetes MDT show that through this open process, and based on lessons from best clinical practice, they were able to continuously improve paediatric diabetes care in Sweden .…”

Section: Discussionmentioning

confidence: 99%

“…There are huge differences in diabetes care throughout the ‘developed’ world , with increasing in some regions unchanged over the decades .…”

Section: Introductionmentioning

confidence: 99%

“…National and international guidelines clearly state that the treatment of type 1 diabetes in childhood and adolescence is a task for a MDT comprising paediatric diabetologists/endocrinologists, diabetes educators/nurses, dietitians, psychologists and social workers . In addition, the philosophy of the MDT and communication between members seem to have a crucial role in treatment results . It has been shown that in paediatric centres where MDT members show high agreement regarding glycaemic targets, e.g.…”

Section: Introductionmentioning

confidence: 99%

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Determinants of glycaemic outcome in the current practice of care for young people up to 21 years old with type 1 diabetes under real‐life conditions

et al. 2019

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AimTo determine factors influencing the success of treatment for type 1 diabetes, defined as HbA 1c < 58 mmol/mol (<7.5%), in a large paediatric cohort under real-life conditions. Methods This is a monocentric observational study analysing the determinants of glycaemic outcome (sex, age, comorbidities, sociodemographic factors, diabetes technology) in an entire cohort of people with diabetes aged up to 21 years. Glycaemic outcome was defined as an individual's median HbA 1c and the prevalence of acute complications over this period. ResultsOf 700 young people with type 1 diabetes [age 13.6 years (range: 1.4-20.9 years); diabetes duration 5.8 years (range: 0.1-18.3 years)], 63% were using an insulin pump and 32% any type of continuous glucose monitoring. Mean HbA 1c was 61 mmol/mol [95% confidence interval (CI) 60-62; 7.7%, 95% CI 7.5-7.8]. Some 63% of children aged < 12 years reached HbA 1c (58 mmol/mol (<7.5%) compared with 43% of older participants. The prevalence of severe hypoglycaemia was 2.41 events and that of diabetic ketoacidosis 1.4 events per 100 person-years. Neither type of insulin therapy nor use of continuous glucose monitoring, sex or comorbidity with coeliac disease or thyroiditis was significantly associated with glycaemic outcome. However, age, diabetes duration, having a father not born in Germany, psychiatric comorbidities and family structure were associated with HbA 1c .Conclusions Current technologies and a multidisciplinary team approach allow high numbers of children and adolescents to realize tight glycaemic control with a low prevalence of acute complications. However, age-related challenges, sociodemographic factors and psychological comorbidities are barriers to achieving best possible glycaemic outcome.

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Section: Discussionmentioning

confidence: 99%

“…There are huge differences in diabetes care throughout the ‘developed’ world , with increasing in some regions unchanged over the decades .…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Determinants of glycaemic outcome in the current practice of care for young people up to 21 years old with type 1 diabetes under real‐life conditions

et al. 2019

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“…In the absence of such data, we advocate personalizing the above glucose targets to achieve an HbA1c of <53 mmol/mol (7.0%). Consistent targets, communication, and teamwork are important in improving HbA1c . See Table for recommended glucose targets to achieve an HbA1c of <53 mmol/mol (7.0%).…”

Section: Fingerstick Bg Measurementsmentioning

confidence: 99%

ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes

et al. 2018

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“…In fact, pediatric HbA1c in the T1DX was higher in the 2017 data than in 2010-2012 data (17). From literature describing efforts to decrease HbA1c (10,18), common themes emerge as potentially critical contributors to success in HbA1c management (9,19,20). These include (1) a unified and consistent team approach; (2) communicating clear glucose targets to youth and their families; (3) flexibility in supporting youth and families; and (4) timely detection of increasing glucose trends followed by rapid intensification of therapy to regain target control.…”

Section: Introductionmentioning

confidence: 99%

Improving Clinical Outcomes in Newly Diagnosed Pediatric Type 1 Diabetes: Teamwork, Targets, Technology, and Tight Control—The 4T Study

et al. 2020

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Many youth with type 1 diabetes (T1D) do not achieve hemoglobin A1c (HbA1c) targets. The mean HbA1c of youth in the USA is higher than much of the developed world. Mean HbA1c in other nations has been successfully modified following benchmarking and quality improvement methods. In this review, we describe the novel 4T approachteamwork, targets, technology, and tight control-to diabetes management in youth with new-onset T1D. In this program, the diabetes care team (physicians, nurse practitioners, certified diabetes educators, dieticians, social workers, psychologists, and exercise physiologists) work closely to deliver diabetes education from diagnosis. Part of the education curriculum involves early integration of technology, specifically continuous glucose monitoring (CGM), and developing a curriculum around using the CGM to maintain tight control and optimize quality of life.

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Targets and teamwork: Understanding differences in pediatric diabetes centers treatment outcomes

Abstract: The diabetes care teams' cohesiveness and perspectives on treatment targets, expectations, and recommendations have an influence on parental targets, contributing to the differences in pediatric diabetes center outcomes.

Cited by 19 publications

References 13 publications

Determinants of glycaemic outcome in the current practice of care for young people up to 21 years old with type 1 diabetes under real‐life conditions

Determinants of glycaemic outcome in the current practice of care for young people up to 21 years old with type 1 diabetes under real‐life conditions

ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes

Improving Clinical Outcomes in Newly Diagnosed Pediatric Type 1 Diabetes: Teamwork, Targets, Technology, and Tight Control—The 4T Study

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