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Outcome of quality management in pediatric diabetes care
1Department of Pediatrics, Glostrup University Hospital, Denmark. hbm@dadlnet.dk
Insights
Screening diabetic children for HbA1c and albumin excretion rate (AER) revealed inadequate treatment. While HbA1c and insulin needs increased with age, persistent microalbuminuria was linked to age and blood pressure, indicating a need for improved childhood diabetes management.
Area of Science:
- Pediatrics
- Endocrinology
- Diabetology
Background:
- Childhood diabetes management and monitoring are critical for long-term health outcomes.
- Glycemic control, assessed by HbA1c, and early detection of kidney complications, like microalbuminuria, are key aspects of diabetes care.
Purpose of the Study:
- To assess the screening of diabetic children for HbA1c and albumin excretion rate (AER) in Denmark.
- To evaluate insulin treatment regimens and identify factors associated with glycemic control and microalbuminuria in children with diabetes.
Main Methods:
- Cross-sectional screening studies conducted in Denmark in 1988 and 1990, involving approximately 1,000 diabetic children each.
- An international survey of 2,873 children with diabetes, analyzing HbA1c levels, insulin treatment types, and prevalence of microalbuminuria.
Main Results:
- HbA1c and insulin requirements increased with age in both sexes. Persistent microalbuminuria prevalence was 4.3%, associated with age and diastolic blood pressure.
- Significant variations in HbA1c were observed between international centers. Severe hypoglycemia was linked to younger age and lower HbA1c.
- Insulin regimen variations included premixed insulin use (37%) and higher proportions of long-acting insulin in very young children. Lower HbA1c in adolescent boys correlated with more short-acting insulin use.
Conclusions:
- Current treatment strategies for childhood diabetes appear inadequate based on observed glycemic control and complication rates.
- Age and blood pressure are significant factors in microalbuminuria development in diabetic children.
- Further research and improved therapeutic approaches are needed to optimize diabetes management in pediatric populations.
Abstract:
In 1988 and 1990 screening for HbAlc and albumin excretion rate (AER) in diabetic children was carried out throughout Denmark. Each study included about 1,000 diabetic patients and found HbAlc and insulin requirements increased during maturation in both sexes. No significant differences in HbAlc were seen among adolescents treated with two, three or more daily insulin injections. The prevalence of persistent microalbuminuria was 4.3% which was associated only with age and diastolic blood pressure. An international survey on HbAlc and insulin treatment, involving 2,873 children, showed HbAlc to vary significantly between centers. Severe hypoglycemia was related to younger age (0-8 years) and lower HbAlc. Of the children on twice and three times daily injections, 37% used a premixed form of insulin. Very young children were treated with a higher proportion of long-acting insulin. Among adolescent boys, lower HbAlc was related to the use of more short-acting insulin. The data confirm that current treatment of childhood diabetes is inadequate.