Persistent Differences Among Centers Over 3 Years in Glycemic Control and Hypoglycemia in a Study of 3,805 Children and Adolescents With Type 1 Diabetes From the Hvidøre Study Group
Open accessAbstract
OBJECTIVE—Twenty-one international pediatric diabetes centers from 17 countries investigated the effect of simple feedback about the grand mean HbA1c level of all centers and the average value of each center on changes in metabolic control, rate of severe hypoglycemia, and insulin therapy over a 3-year period. RESEARCH DESIGN AND METHODS—Clinical data collection and determination of HbA1c levels were conducted at a central location in 1995 (n = 2,780, age 0–18 years) and 1998 (n = 2,101, age 11–18 years). RESULTS—Striking differences in average HbA1c concentrations were found among centers; these differences remained after adjustment for the significant confounders of sex, age, and diabetes duration. They were apparent even in patients with short diabetes duration and remained stable 3 years later (mean adjusted HbA1c level: 8.62 ± 0.03 vs. 8.67 ± 0.04 [1995 vs. 1998, respectively]). Three centers had improved significantly, four centers had deteriorated significantly in their overall adjusted HbA1c levels, and 14 centers had not changed in glycemic control. During the observation period, there were increases in the adjusted insulin dose by 0.076 U/kg, the adjusted number of injections by 0.23 injections per day, and the adjusted BMI by 0.95 kg/m2. The 1995 versus 1998 difference in glycemic control for the seven centers could not be explained by prevailing insulin regimens or rates of hypoglycemia. CONCLUSIONS—This study reveals significant outcome differences among large international pediatric diabetes centers. Feedback and comparison of HbA1c levels led to an intensification of insulin therapy in most centers, but improved glycemic control in only a few.
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The DCCT demonstrated that intensive glycemic control reduces the long-term vascular complications of hyperglycemia in type 1 diabetes.
“The DCCT demonstrated that intensive glycemic control reduces the long-term vascular complications of hyperglycemia in T1D.”
From Epidemiology of type 1 diabetes (2010) · cites this paper as [86]
Rates of hypoglycemia were higher in adolescents than in adults.
“Despite this, rates of hypoglycemia were higher in adolescents than in adults86.”
From Epidemiology of type 1 diabetes (2010) · cites this paper as [86]
Intensive glycemic control improves vascular outcomes in type 1 diabetes.
“Of note, these data from Hvidore and SEARCH are post-DCCT in which it has been shown conclusively that intensive glycemic control improves vascular outcomes in T1D.”
From Epidemiology of type 1 diabetes (2010) · cites this paper as [86]
In the DCCT, mean A1c for adolescents compared with adults was 1-2% higher in both the intensive and conventionally treated arms.
“However, even in the Diabetes Control and Complications Trial (DCCT) the mean A1c for adolescents as compared to adults was 1–2% higher in both the intensive and conventionally treated arms.”
From Epidemiology of type 1 diabetes (2010) · cites this paper as [86]
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- Authors
- Danne, T., Mortensen, H. B., Hougaard, P., Lynggaard, H., Aanstoot, H.-J., Chiarelli, F., Daneman, D., Dorchy, H., Garandeau, P., Greene, S. A., Hoey, H., Holl, R. W., Kaprio, E. A., Kocova, M., Martul, P., Matsuura, N., Robertson, K. J., Schoenle, E. J., Søvik, O., Swift, P. G. F., Tsou, R. M., Vanelli, M., Åman, J., & for the Hvidøre Study Group on Childhood Diabetes
- Affiliations
- Humboldt-Universität zu Berlin (DE)
- Glostrup Hospital (DK)
- Novo Nordisk (Denmark) (DK)
- Erasmus MC - Sophia Children’s Hospital (NL)
- University of Chieti-Pescara (IT)
- University of Toronto (CA)
- Queen Fabiola Children's University Hospital (BE)
- Institut St. Pierre, Montpellier, France
- Ninewells Hospital (GB)
- Tallaght University Hospital (IE)
- Universität Ulm (DE)
- Peijas Hospital (FI)
- University Pediatric Clinic, Skopje, Republic of Macedonia
- Hospital de Cruces (ES)
- Kitasato University (JP)
- Royal Hospital for Children (GB)
- University Children's Hospital Zurich (CH)
- Department of Pediatrics, Haukeland Hospital, Bergen, Norway
- Leicester Royal Infirmary (GB)
- Hospital de São João (PT)
- University of Parma (IT)
- Örebro Regional Hospital, Örebro, Sweden
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2001-08-01
- Volume
- 24
- Issue
- 8
- Pages
- 1342-1347
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2166158593
- Cited by
- 299
- References
- 19
- Citations by year
- 2025: 2 · 2023: 2 · 2022: 4 · 2021: 5 · 2020: 2 · 2019: 6 · 2018: 5 · 2017: 10 · 2016: 12 · 2015: 9 · 2014: 19 · 2013: 17 · 2012: 27
- FWCI
- 6.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
- Funders
- Novo Nordisk
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 1 diabetes, pediatric diabetes, glycemic control, HbA1c, hypoglycemia, insulin therapy, performance feedback
- MeSH terms
- Adolescent, Blood Glucose, Child, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Europe, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Insulin, Japan, Male, North America, Reproducibility of Results, Biomarkers, Incidence
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