title: Metabolic outcomes in young children with type 1 diabetes differ between treatment centers: the Hvidoere Study in Young Children 2009.
abstract: OBJECTIVE
  To investigate whether center differences in glycemic control are present in prepubertal children <11 yr with type 1 diabetes mellitus.
  
  
  METHODS
  This cross-sectional study involved 18 pediatric centers worldwide. All children, <11 y with a diabetes duration ≥12 months were invited to participate. Case Record Forms included information on clinical characteristics, insulin regimens, diabetic ketoacidosis (DKA), severe hypoglycemia, language difficulties, and comorbidities. Hemoglobin A1c (HbA1c) was measured centrally by liquid chromatography (DCCT aligned, range: 4.4-6.3%; IFFC: 25-45 mmol/mol).
  
  
  RESULTS
  A total of 1133 children participated (mean age: 8.0 ± 2.1 y; females: 47.5%, mean diabetes duration: 3.8 ± 2.1 y). HbA1c (overall mean: 8.0 ± 1.0%; range: 7.3-8.9%) and severe hypoglycemia frequency (mean 21.7 events per 100 patient-years), but not DKA, differed significantly between centers (p < 0.001 resp. p = 0.179). Language difficulties showed a negative relationship with HbA1c (8.3 ± 1.2% vs. 8.0 ± 1.0%; p = 0.036). Frequency of blood glucose monitoring demonstrated a significant but weak association with HbA1c (r = -0.17; p < 0.0001). Although significant different HbA1c levels were obtained with diverse insulin regimens (range: 7.3-8.5%; p < 0.001), center differences remained after adjusting for insulin regimen (p < 0.001). Differences between insulin regimens were no longer significant after adjusting for center effect (p = 0.199).
  
  
  CONCLUSIONS
  Center differences in metabolic outcomes are present in children <11 yr, irrespective of diabetes duration, age, or gender. The incidence of severe hypoglycemia is lower than in adolescents despite achieving better glycemic control. Insulin regimens show a significant relationship with HbA1c but do not explain center differences. Each center's effectiveness in using specific treatment strategies remains the key factor for outcome.
authors.affiliation: Pediatric Clinic, Centre Hospitalier de Luxembourg, Luxembourg, GD de Luxembourg. debeaufort.carine@chl.lu
authors.forename: Carine E
authors.initials: CE
authors.lastname: de Beaufort
authors.forename: Karin
authors.initials: K
authors.lastname: Lange
authors.forename: Peter G F
authors.initials: PG
authors.lastname: Swift
authors.forename: Jan
authors.initials: J
authors.lastname: Aman
authors.forename: Fergus
authors.initials: F
authors.lastname: Cameron
authors.forename: Luis
authors.initials: L
authors.lastname: Castano
authors.forename: Harry
authors.initials: H
authors.lastname: Dorchy
authors.forename: Lynda K
authors.initials: LK
authors.lastname: Fisher
authors.forename: Hilary
authors.initials: H
authors.lastname: Hoey
authors.forename: Eero
authors.initials: E
authors.lastname: Kaprio
authors.forename: Mirjana
authors.initials: M
authors.lastname: Kocova
authors.forename: Andreas
authors.initials: A
authors.lastname: Neu
authors.forename: Pal R
authors.initials: PR
authors.lastname: Njolstad
authors.forename: Moshe
authors.initials: M
authors.lastname: Phillip
authors.forename: Eugen
authors.initials: E
authors.lastname: Schoenle
authors.forename: Jean J
authors.initials: JJ
authors.lastname: Robert
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Urukami
authors.forename: Maurizio
authors.initials: M
authors.lastname: Vanelli
authors.forename: Thomas
authors.initials: T
authors.lastname: Danne
authors.forename: Tim
authors.initials: T
authors.lastname: Barrett
authors.forename: Franco
authors.initials: F
authors.lastname: Chiarelli
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Aanstoot
authors.forename: Henrik B
authors.initials: HB
authors.lastname: Mortensen
mesh_terms: D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016883:Diabetic Ketoacidosis / Q000139:chemically induced / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000517:prevention & control*; D007003:Hypoglycemia / Q000453:epidemiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human