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Metabolic outcomes in young children with type 1 diabetes differ between treatment centers: the Hvidoere Study in

Carine E de Beaufort1, Karin Lange, Peter G F Swift

  • 1Pediatric Clinic, Centre Hospitalier de Luxembourg, Luxembourg, GD de Luxembourg. debeaufort.carine@chl.lu

Pediatric Diabetes
|September 11, 2012
PubMed

Insights

Center differences significantly impact glycemic control in children under 11 with type 1 diabetes. Center effectiveness in treatment strategies, not insulin regimens, is key to outcomes.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Clinical Research

Background:

  • Glycemic control in type 1 diabetes mellitus (T1DM) is crucial for preventing long-term complications.
  • Variability in clinical outcomes across pediatric centers managing T1DM suggests potential differences in care quality or approach.

Purpose of the Study:

  • To determine if significant variations in glycemic control exist among pediatric centers treating prepubertal children (<11 years) with T1DM.
  • To identify factors contributing to these center-specific differences in metabolic outcomes.

Main Methods:

  • A cross-sectional study involving 1133 children (<11 years) with T1DM duration of at least 12 months across 18 international pediatric centers.
  • Data collected included clinical characteristics, insulin regimens, diabetic ketoacidosis (DKA), severe hypoglycemia, language difficulties, and comorbidities.
  • Centralized Hemoglobin A1c (HbA1c) measurement using liquid chromatography; statistical analysis to compare center outcomes.

Main Results:

  • Significant differences were observed between centers in HbA1c levels (overall mean 8.0 ± 1.0%) and the frequency of severe hypoglycemia.
  • Center differences in HbA1c persisted even after adjusting for insulin regimens, indicating other factors are influential.
  • Language difficulties were negatively associated with HbA1c, and blood glucose monitoring frequency showed a weak negative correlation.

Conclusions:

  • Substantial center-specific variations in metabolic outcomes exist for prepubertal children with T1DM, independent of patient demographics or diabetes duration.
  • While insulin regimens are related to HbA1c, they do not account for the observed center differences, highlighting the importance of center-specific treatment strategy effectiveness.
  • The incidence of severe hypoglycemia is lower in this younger cohort compared to adolescents, despite achieving better glycemic control.
Abstract

Keywords:
HbA1cchildrenglycemic controltype 1 diabetes mellitus

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