title: Possibilities and challenges of a large international benchmarking in pediatric diabetology-The SWEET experience.
abstract: Despite the existence of evidence-based guidelines for the care of children with diabetes, widespread gaps in knowledge, attitude, and practice remain. The purpose of this paper is to present a review of benchmarking practices and results of this process within SWEET, moreover focusing on current challenges and future directions.
  
  
  
  Biannually, members electronically transfer de-identified clinic data for 37 parameters to the SWEET database. Each center receives benchmarking and data validation reports.
  
  
  
  In 2015, 48 centers have contributed data for 20 165 unique patients (51.6% male). After exclusion for missing data 19 131 patients remain for further analysis. The median age is 14.2 years, with a median diabetes duration 4.8 years; 96.0% of patients have type 1, 1.1% type 2, and 2.9% other diabetes types. Data completeness has increased over time. In 2015, median HbA1c of all patients' (diabetes type 1) medians was 7.8% (61.7 mmol/mol) with 39.1%, 41.4%, and 19.4% of patients having HbA1c < 7.5% (58 mmol/mol), 7.5%-9% (58-75 mmol/mol) and >9% (75 mmol/mol), respectively. Although HbA1c has been stable over time [7.7%-7.8% (60.7-61.7 mmol/mol)], there remains wide variation between centers. Fourteen centers achieve a median HbA1c <7.5% (58 mmol/mol).
  
  
  
  Our vision is that the participation in SWEET is encouraging members to deliver increasingly accurate and complete data. Dissemination of results and prospective projects serve as further motivation to improve data reporting. Comparing processes and outcomes will help members identify weaknesses and introduce innovative solutions, resulting in improved and more uniform care for patients with diabetes.
authors.affiliation: DECCP, Clinique Pédiatrique Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
authors.forename: Michael
authors.initials: M
authors.lastname: Witsch
authors.affiliation: Agia Sophia Children's Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Kosteria
authors.affiliation: Diabetes Centre for Children and Adolescents, Kinderkrankenhaus Auf der Bult, Hannover, Germany.
authors.forename: Olga
authors.initials: O
authors.lastname: Kordonouri
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, USA.
authors.forename: Guy
authors.initials: G
authors.lastname: Alonso
authors.affiliation: Clinic of Endocrinology, Diabetes and Genetics, University Pediatric Hospital, Medical University - Sofia, Bulgaria, Sofia, Bulgaria.
authors.forename: Margarita
authors.initials: M
authors.lastname: Archinkova
authors.affiliation: NGO, Santé Diabète Délégation Mali, Bamako, Mali.
authors.forename: Stephane
authors.initials: S
authors.lastname: Besancon
authors.affiliation: Department of Paediatrics, Aarhus University Hospital, Skejby, Department of Pediatrics, Aarhus, Denmark.
authors.forename: Niels H
authors.initials: NH
authors.lastname: Birkebæk
authors.affiliation: Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, Ljubljana, Slovenia.
authors.forename: Natasa
authors.initials: N
authors.lastname: Bratina
authors.affiliation: Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy.
authors.forename: Valentino
authors.initials: V
authors.lastname: Cherubini
authors.affiliation: Department of Pediatrics, NU Hospital Group, Uddevalla, Sweden.
authors.forename: Ragnar
authors.initials: R
authors.lastname: Hanas
authors.affiliation: Diacare-Diabetes Care & Hormone Clinic, Ahmedabad, India.
authors.forename: Dhruvi
authors.initials: D
authors.lastname: Hasnani
authors.affiliation: First Clinic of Pediatric Endocrinology, University Hospital 'Sv. Marina', Varna, Bulgaria.
authors.forename: Violeta
authors.initials: V
authors.lastname: Iotova
authors.affiliation: APDP - Portuguese Diabetes Association, Lisbon, Portugal.
authors.forename: João Filipe
authors.initials: JF
authors.lastname: Raposo
authors.affiliation: Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.|German Center for Diabetes Research (DZD), Munich, Germany.
authors.forename: Anke
authors.initials: A
authors.lastname: Schwandt
authors.affiliation: Department of Pediatrics, University Hospital Motol Prague, Prague, Czech Republic.
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Sumnik
authors.affiliation: Pediatric Department, Herlev University Hospital, Copenhagen, Denmark.
authors.forename: Jannet
authors.initials: J
authors.lastname: Svensson
authors.affiliation: Centre for Pediatric and Young Adult Diabetes Care and Research, Rotterdam, The Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: Veeze
mesh_terms: D000293:Adolescent; D019985:Benchmarking; D002648:Child; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000592:standards
keywords: benchmarking; diabetes; international comparison; pediatric