title: Care delivery and outcomes among Belgian children and adolescents with type 1 diabetes.
abstract: We aimed to investigate care processes and outcomes among children and adolescents with type 1 diabetes treated in hospital-based multidisciplinary paediatric diabetes centres. Our retrospective cross-sectional study among 12 Belgian centres included data from 974 patients with type 1 diabetes, aged 0-18 years. Questionnaires were used to collect data on demographic and clinical characteristics, as well as process of care completion and outcomes of care in 2008. Most patients lived with both biological or adoption parents (77 %) and had at least one parent of Belgian origin (78 %). Nearly all patients (≥95 %) underwent determination of HbA(1c) and BMI. Screening for retinopathy (55 %) and microalbuminuria (73 %) was less frequent, but rates increased with age and diabetes duration. Median HbA(1c) was 61 mmol/mol (7.7 %) [interquartile range 54-68 mmol/mol (7.1-8.4 %)] and increased with age and insulin dose. HbA(1c) was higher among patients on insulin pump therapy. Median HbA(1c) significantly differed between centres [from 56 mmol/mol (7.3 %) to 66 mmol/mol (8.2 %)]. Incidence of severe hypoglycaemia was 30 per 100 patient-years. Admissions for ketoacidosis had a rate of 3.2 per 100 patient-years. Patients not living with both biological or adoption parents had higher HbA(1c) and more admissions for ketoacidosis. Parents' country of origin was not associated with processes and outcomes of care.
  
  
  CONCLUSIONS
  Outcomes of care ranked well compared to other European countries, while complication screening rates were intermediate. The observed centre variation in HbA(1c) remained unexplained. Outcomes were associated with family structure, highlighting the continuing need for strategies to cope with this emerging challenge.
authors.affiliation: .Health Services Research Unit, Scientific Institute of Public Health, Rue J. Wytsman 14, 1050 Brussels, Belgium, kris.doggen@wiv-isp.be
authors.forename: K
authors.initials: K
authors.lastname: Doggen
authors.forename: N
authors.initials: N
authors.lastname: Debacker
authors.forename: D
authors.initials: D
authors.lastname: Beckers
authors.forename: K
authors.initials: K
authors.lastname: Casteels
authors.forename: M
authors.initials: M
authors.lastname: Coeckelberghs
authors.forename: L
authors.initials: L
authors.lastname: Dooms
authors.forename: H
authors.initials: H
authors.lastname: Dorchy
authors.forename: M
authors.initials: M
authors.lastname: Lebrethon
authors.forename: K
authors.initials: K
authors.lastname: Logghe
authors.forename: M
authors.initials: M
authors.lastname: Maes
authors.forename: G
authors.initials: G
authors.lastname: Massa
authors.forename: T
authors.initials: T
authors.lastname: Mouraux
authors.forename: R
authors.initials: R
authors.lastname: Rooman
authors.forename: G
authors.initials: G
authors.lastname: Thiry-Counson
authors.forename: S
authors.initials: S
authors.lastname: Van Aken
authors.forename: J
authors.initials: J
authors.lastname: Vanbesien
authors.forename: V
authors.initials: V
authors.lastname: Van Casteren
mesh_terms: D000293:Adolescent; D001530:Belgium; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D019538:Health Care Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D016012:Poisson Distribution; D058996:Quality Improvement; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human