title: Temporal trends in the treatment of pediatric type 1 diabetes and impact on acute outcomes.
abstract: OBJECTIVE
  To evaluate temporal trends in pediatric type 1 diabetes (T1DM) management and resultant effects on outcomes.
  
  
  METHODS
  Two pediatric T1DM cohorts were followed prospectively for 2 years and compared; Cohort 1 (N = 299) was enrolled in 1997 and Cohort 2 (N = 152) was enrolled in 2002. In both cohorts, eligible participants were identified and sequentially approached at regularly scheduled clinic visits until the target number of participants was reached. Main outcome measures were hemoglobin A1c (A1c), body mass index Z score (Z-BMI), and incidence rate (IR; per 100 patient-years) of hypoglycemia, hospitalizations, and emergency room (ER) visits.
  
  
  RESULTS
  At baseline, Cohort 2 monitored blood glucose more frequently than Cohort 1 (> or = 4 times/day: 72% vs 39%, P < .001) and was prescribed more intensive therapy than Cohort 1 (> or = 3 injections/day or pump: 85% vs 65%, P < .001). A1c was lower in Cohort 2 than Cohort 1 at baseline (8.4% vs 8.7%, P = .03) and study's end (8.7% vs 9.0%, P = .04). The cohorts did not differ in Z-BMI (0.83 vs 0.79, P = .57) or IR of hospitalizations (11.2 vs 12.9, P = .38). Cohort 2 had lower IR of total severe hypoglycemic events (29.4 vs 55.4, P < .001) and ER visits (22.0 vs 29.3, P = .02).
  
  
  CONCLUSIONS
  T1DM management intensified during the 5 years between cohorts and was accompanied by improved A1c and stable Z-BMI. Along with improved control, IR of severe hypoglycemia and ER visits decreased by almost 50% and 25%, respectively.
authors.affiliation: Pediatric and Adolescent Section, Joslin Diabetes Center, Boston, Massachusetts 02215, USA.
authors.forename: Britta M
authors.initials: BM
authors.lastname: Svoren
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Volkening
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Butler
authors.forename: Elaine C
authors.initials: EC
authors.lastname: Moreland
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Anderson
authors.forename: Lori M B
authors.initials: LM
authors.lastname: Laffel
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring; D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000188:drug therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005951:Glucose Tolerance Test; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology / Q000517:prevention & control*; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin