title: 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.
abstract: OBJECTIVE
  Twenty-one international pediatric diabetes centers from 17 countries investigated the effect of simple feedback about the grand mean HbA(1c) 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.
  
  
  METHODS
  Clinical data collection and determination of HbA(1c) 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 HbA(1c) 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 HbA(1c) 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 HbA(1c) 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/m(2). 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 HbA(1c) levels led to an intensification of insulin therapy in most centers, but improved glycemic control in only a few.
authors.affiliation: Charité Children's Hospital, Humboldt University, Berlin, Germany. danne@hka.de
authors.forename: T
authors.initials: T
authors.lastname: Danne
authors.forename: H B
authors.initials: HB
authors.lastname: Mortensen
authors.forename: P
authors.initials: P
authors.lastname: Hougaard
authors.forename: H
authors.initials: H
authors.lastname: Lynggaard
authors.forename: H J
authors.initials: HJ
authors.lastname: Aanstoot
authors.forename: F
authors.initials: F
authors.lastname: Chiarelli
authors.forename: D
authors.initials: D
authors.lastname: Daneman
authors.forename: H
authors.initials: H
authors.lastname: Dorchy
authors.forename: P
authors.initials: P
authors.lastname: Garandeau
authors.forename: S A
authors.initials: SA
authors.lastname: Greene
authors.forename: H
authors.initials: H
authors.lastname: Hoey
authors.forename: R W
authors.initials: RW
authors.lastname: Holl
authors.forename: E A
authors.initials: EA
authors.lastname: Kaprio
authors.forename: M
authors.initials: M
authors.lastname: Kocova
authors.forename: P
authors.initials: P
authors.lastname: Martul
authors.forename: N
authors.initials: N
authors.lastname: Matsuura
authors.forename: K J
authors.initials: KJ
authors.lastname: Robertson
authors.forename: E J
authors.initials: EJ
authors.lastname: Schoenle
authors.forename: O
authors.initials: O
authors.lastname: Søvik
authors.forename: P G
authors.initials: PG
authors.lastname: Swift
authors.forename: R M
authors.initials: RM
authors.lastname: Tsou
authors.forename: M
authors.initials: M
authors.lastname: Vanelli
authors.forename: J
authors.initials: J
authors.lastname: Aman
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D005060:Europe; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology* / Q000517:prevention & control*; D015994:Incidence; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D007564:Japan; D008297:Male; D009656:North America; D015203:Reproducibility of Results
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin