Article Text

INTENSIVE INSULIN MANAGEMENT: AN ATTITUDE NOT A REGIMEN—THE HVIDOERE STUDY GROUP FOR CHILDHOOD DIABETES EXPLORING CENTRE DIFFERENCES 2005
  1. C E de Beaufort1,
  2. T C Skinner2,
  3. P G Swift3,
  4. H S G Hvidoere Study Group3
  1. 1DECCP, Clinique Pédiatrique de Luxembourg, Luxembourg, Luxembourg,
  2. 2Department of Psychology, University of Wollongong, Wollongong, NSW, Australia,
  3. 3Leicester Royal Infirmary, Children’s Hospital, Leicester, UK

Abstract

Objective: Evaluate glycaemic targets set by diabetes teams, their perception by adolescents and parents and their influence on metabolic control in a large international cohort of adolescents with type 1 diabetes.

Methodology: Cross-sectional clinical data were collected and questionnaires completed by adolescents and parents/carers attending 21 international centres. Haemoglobin A1c (HbA1c) (DCCT adjusted) was measured centrally.

Results: Questionnaires were completed by 2062 adolescents (age 14.4 ± 2.3 years; 50.6% male; diabetes duration 6.1 ± 3.5 years). Mean HbA1c was 8.2% ± 1.4 with significant difference between centres (F  =  12.3; p<0.001); range 7.4–9.3%. There was significant correlation between parent (r  =  0.20) and adolescent (r  =  0.21) reports of their ideal HbA1c and actual results and stronger association between what parents (r  =  0.39) and adolescents (r  =  0.4) report as the HbA1c they would be happy with and the actual result. There were significant differences between centres on both parent and adolescent reports of ideal HbA1c and the result they would be happy with (8.1< F >17.4; p<0.001). Greater consistency between various members of a team within a centre was associated with lower HbA1c. Adding these variables as covariates substantially reduces the effect of centre on HbA1c (centre alone F  =  12.3; controlling for covariate centre effect F  =  3.27).

Conclusions: Clear and consistent setting of glycaemic targets by diabetes teams is strongly associated with HbA1c outcome in adolescents. Target setting appears to play a significant role in explaining the differences in metabolic outcomes between centres.

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