The influence of structure, process, and policy on HbA(1c) levels in treatment of children and adolescents with type 1 diabetes.
OBJECTIVE
To identify factors which improve glycaemic control measured as HbA(1c) in children and adolescents with diabetes treated at paediatric departments.


METHODS
Through data from the Swedish paediatric diabetes quality registry, SWEDIABKIDS, five centres respectively with the lowest, highest, and largest decrease in centre mean HbA(1c) (Low, High, Decrease HbA(1c) centres) were identified. Diabetes team members completed questionnaires (109 of 128 responded) and reported team structure, process and policy. Open-ended questions were analysed with summative content analysis.


RESULTS
Compared to the High HbA(1c) centres, the Low and Decrease HbA(1c) centres showed higher compliance with guidelines, although they had shorter professional experience and lower proportion of special diabetes-educated team members. A clear message was given and the centres aimed at a lower HbA(1c) target value. Team members were devoted, had a positive attitude and perception of a well-functioning team. Trends for higher mean insulin dose and larger centre size were found. High HbA(1c) centres gave a vague message and had a perception of lack of cooperation in the team.


CONCLUSIONS
Team members' policy and approaches affect glycaemic control in children and adolescents. Team members need to be aware of their approach and of the importance of using resources within the team.
Department of Clinical and Experimental Medicine, Linköping University, Sweden. lena.hanberger@lio.se
L
L
Hanberger
U
U
Samuelsson
C
C
Berterö
J
J
Ludvigsson
D000293:Adolescent; D001291:Attitude of Health Personnel; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D019983:Guideline Adherence; D006291:Health Policy; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012042:Registries; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human