Forskning
Udskriv Udskriv
Switch language
Region Hovedstaden - en del af Københavns Universitetshospital
Udgivet

Exploring Variation in Glycemic Control Across and Within Eight High-Income Countries: A Cross-sectional Analysis of 64,666 Children and Adolescents With Type 1 Diabetes

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

DOI

  1. Cost of Treating Skin Problems in Patients with Diabetes who Use Insulin Pumps and/or Glucose Sensors

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Bone turnover markers during the remission phase in children and adolescents with type 1 diabetes

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. Childhood adversities and type 1 diabetes risk

    Publikation: Bog/antologi/afhandling/rapportPh.d.-afhandlingForskning

  • Dimitrios Charalampopoulos
  • Julia M Hermann
  • Jannet Svensson
  • Torild Skrivarhaug
  • David M Maahs
  • Karin Akesson
  • Justin T Warner
  • Reinhard W Holl
  • Niels H Birkebæk
  • Ann K Drivvoll
  • Kellee M Miller
  • Ann-Marie Svensson
  • Terence Stephenson
  • Sabine E Hofer
  • Siri Fredheim
  • Siv J Kummernes
  • Nicole Foster
  • Lena Hanberger
  • Rakesh Amin
  • Birgit Rami-Merhar
  • Anders Johansen
  • Knut Dahl-Jørgensen
  • Mark Clements
  • Ragnar Hanas
Vis graf over relationer

OBJECTIVE: International studies on childhood type 1 diabetes (T1D) have focused on whole-country mean HbA1c levels, thereby concealing potential variations within countries. We aimed to explore the variations in HbA1c across and within eight high-income countries to best inform international benchmarking and policy recommendations.

RESEARCH DESIGN AND METHODS: Data were collected between 2013 and 2014 from 64,666 children with T1D who were <18 years of age across 528 centers in Germany, Austria, England, Wales, U.S., Sweden, Denmark, and Norway. We used fixed- and random-effects models adjusted for age, sex, diabetes duration, and minority status to describe differences between center means and to calculate the proportion of total variation in HbA1c levels that is attributable to between-center differences (intraclass correlation [ICC]). We also explored the association between within-center variation and children's glycemic control.

RESULTS: Sweden had the lowest mean HbA1c (59 mmol/mol [7.6%]) and together with Norway and Denmark showed the lowest between-center variations (ICC ≤4%). Germany and Austria had the next lowest mean HbA1c (61-62 mmol/mol [7.7-7.8%]) but showed the largest center variations (ICC ∼15%). Centers in England, Wales, and the U.S. showed low-to-moderate variation around high mean values. In pooled analysis, differences between counties remained significant after adjustment for children characteristics and center effects (P value <0.001). Across all countries, children attending centers with more variable glycemic results had higher HbA1c levels (5.6 mmol/mol [0.5%] per 5 mmol/mol [0.5%] increase in center SD of HbA1c values of all children attending a specific center).

CONCLUSIONS: At similar average levels of HbA1c, countries display different levels of center variation. The distribution of glycemic achievement within countries should be considered in developing informed policies that drive quality improvement.

OriginalsprogEngelsk
TidsskriftDiabetes Care
Vol/bind41
Udgave nummer6
Sider (fra-til)1180-1187
Antal sider8
ISSN1935-5548
DOI
StatusUdgivet - jun. 2018

ID: 56216358