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Hanberger, Lena
Publications (10 of 21) Show all publications
Samuelsson, U., Åkesson, K., Peterson, A., Hanas, R. & Hanberger, L. (2018). Continued improvement of metabolic control in Swedish pediatric diabetes care. Pediatric Diabetes, 19(1), 150-157
Open this publication in new window or tab >>Continued improvement of metabolic control in Swedish pediatric diabetes care
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2018 (English)In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 19, no 1, p. 150-157Article in journal (Refereed) Published
Abstract [en]

Background: To prospectively investigate if the grand mean HbA1c and the differences in mean HbA1c between centers in Sweden could be reduced, thereby improving care delivered by pediatric diabetes teams. Methods: We used an 18-month quality improvement collaborative (QIC) together with the Swedish pediatric diabetes quality registry (SWEDIABKIDS). The first program (IQ-1), started in April 2011 and the second (IQ-2) in April 2012; together they encompassed 70% of Swedish children and adolescents with diabetes. Results: The proportion of patients in IQ-1 with a mean HbA1c amp;lt;7.4% (57 mmol/mol) increased from 26.4% before start to 35.9% at 36 months (P amp;lt; .001), and from 30.2% to 37.2% (P amp;lt; .001) for IQ-2. Mean HbA1c decreased in both participating and non-participating (NP) centers in Sweden, thereby indicating an improvement by a spatial spill over effect in NP centers. The grand mean HbA1c decreased by 0.45% (4.9 mmol/mol) during 36 months; at the end of 2014 it was 7.43% (57.7 mmol/mol) (P amp;lt; .001). A linear regression model with the difference in HbA1c before start and second follow-up as dependent variable showed that QIC participation significantly decreased mean HbA1c both for IQ-1 and IQ-2. The proportion of patients with high HbA1c values (amp;gt;8.7%, 72 mmol/mol) decreased significantly in both QICs, while it increased in the NP group. Conclusions: The grand mean HbA1c has decreased significantly in Sweden from 2010 to 2014, and QICs have contributed significantly to this decrease. There seems to be a spatial spill-over effect in NP centers.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
diabetes mellitus type 1; hemoglobin A1c protein; human; pediatrics; quality of health care
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:liu:diva-145124 (URN)10.1111/pedi.12467 (DOI)000423397600021 ()27807917 (PubMedID)
Note

Funding Agencies|Association of Local Authorities and Regions in Sweden, SALAR; Futurum-the Academy for Healthcare, Jonkoping County Council

Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2019-05-02
Charalampopoulos, D., Hermann, J. M., Svensson, J., Skrivarhaug, T., Maahs, D. M., Åkesson, K., . . . Hanas, R. (2018). 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. Diabetes Care, 41(6), 1180-1187
Open this publication in new window or tab >>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
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2018 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 41, no 6, p. 1180-1187Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE International studies on childhood type 1 diabetes (T1D) have focused on whole-country mean HbA(1c) levels, thereby concealing potential variations within countries. We aimed to explore the variations in HbA(1c) 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 amp;lt; 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 HbA(1c) levels that is attributable to between-center differences (intraclass correlation [ICC]). We also explored the association between within-center variation and childrens glycemic control. RESULTS Sweden had the lowest mean HbA(1c) (59mmol/mol [7.6%]) and together with Norway and Denmark showed the lowest between-center variations (ICC amp;lt;= 4%). Germany and Austria had the next lowest mean HbA(1c) (61-62 mmol/mol [7.7-7.8%]) but showed the largest center variations (ICC similar to 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 amp;lt; 0.001). Across all countries, children attending centers with more variable glycemic results had higher HbA(1c) levels (5.6mmol/mol [0.5%] per 5mmol/mol [0.5%] increase in center SD of HbA(1c) values of all children attending a specific center). CONCLUSIONS A tsimilar average levels of HbA(1c), 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.

Place, publisher, year, edition, pages
AMER DIABETES ASSOC, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-148378 (URN)10.2337/dc17-2271 (DOI)000432673000023 ()29650804 (PubMedID)
Note

Funding Agencies|England Department of Health Policy Research Programme [10090001]; National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children National Health Service Foundation Trust; University College London; National Health Service England; Welsh Government; South Eastern Norway Regional Health Authority; Health Research Fund of Central Denmark Region; Swedish Association of Local Authorities and Regions (SALAR); German Center for Diabetes Research (DZD); German Diabetes Association (DDG); European Foundation for the Study of Diabetes (EFSD); EU-IMI2 consortium INNODIA; Helmsley Charitable Trust; National Institute of Diabetes and Digestive and Kidney Diseases; Eunice Kennedy Shriver National Institute of Child Health and Human Development; Jaeb Center for Health Research

Available from: 2018-06-15 Created: 2018-06-15 Last updated: 2019-05-02
Hanberger, L., Samuelsson, U., Holl, R. W., Froehlich-Reiterer, E., Åkesson, K. & Hofer, S. (2018). Type 1 diabetes during adolescence: International comparison between Germany, Austria, and Sweden. Pediatric Diabetes, 19(3), 506-511
Open this publication in new window or tab >>Type 1 diabetes during adolescence: International comparison between Germany, Austria, and Sweden
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2018 (English)In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 19, no 3, p. 506-511Article in journal (Refereed) Published
Abstract [en]

Objectives: By using pediatric diabetes quality registries in Austria, Germany, and Sweden treatment of type 1 diabetes and the outcome of care during the vulnerable adolescence period were compared. Methods: Data in DPV, broadly used in Austria and Germany, and Swediabkids used in Sweden, from clinical visits in the year 2013 on 14 383 patients aged 11 to 16 years regarding hemoglobin A1c (HbA1c), insulin regimen, body mass index (BMI)-SD score (SDS), blood pressure, hypoglycemia, ketoacidosis, and smoking habits were analyzed. Results: Patients in Sweden had fewer clinical visits per year (P amp;lt; .05), lower insulin dose per kg (P amp;lt; .001), and lower proportion of fast acting insulin compared with Germany and Austria (P amp;lt; .001). The proportion of pump users was higher in Sweden (P amp;lt; .001). Patients in Sweden had lower mean HbA1c levels (Austria: 64 mmol/mol, Germany: 63 mmol/mol, and Sweden: 61 mmol/mol [8.0%, 7.9%, and 7.7%, respectively]; P amp;lt; .001). The frequency of severe hypoglycemia was higher in Sweden while it was lower for ketoacidosis (3.3% and 1.1%, respectively) than in Austria (1.1% and 5.3%) and Germany (2.0% and 4.4%) (P amp;lt; .001). Girls in all 3 countries had higher HbA1c and BMI-SDS than boys. Conclusions: Sharing data between diabetes registries and nations enables us to better understand differences in diabetes outcome between countries. In this particular comparison, pediatric patients with diabetes in Sweden were more often treated with insulin pump, had lower HbA1c levels and a higher rate of severe hypoglycemia. Patients in Austria and Germany used rapid acting insulin analogs more often and had a lower rate of ketoacidosis.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
adolescents; metabolic control; quality of care; quality registry; type 1 diabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:liu:diva-147919 (URN)10.1111/pedi.12591 (DOI)000430921600025 ()28940551 (PubMedID)
Note

Funding Agencies|Swedish Association of Local Authorities and Regions (SALAR); German Center for Diabetes Research (DZD); European Foundation for the Study of Diabetes (EFSD); German Diabetes Association

Available from: 2018-05-23 Created: 2018-05-23 Last updated: 2019-05-02
Samuelsson, U., Anderzen, J., Gudbjornsdottir, S., Steineck, I., Akesson, K. & Hanberger, L. (2016). Teenage girls with type 1 diabetes have poorer metabolic control than boys and face more complications in early adulthood. Journal of diabetes and its complications, 30(5), 917-922
Open this publication in new window or tab >>Teenage girls with type 1 diabetes have poorer metabolic control than boys and face more complications in early adulthood
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2016 (English)In: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 30, no 5, p. 917-922Article in journal (Refereed) Published
Abstract [en]

Aims: To compare metabolic control between males and females with type 1 diabetes during adolescence and as young adults, and relate it to microvascular complications. Methods: Data concerning 4000 adolescents with type 1 diabetes registered in the Swedish paediatric diabetes quality registry, and above the age of 18 years in the Swedish National Diabetes Registry was used. Results: When dividing HbA1c values in three groups; amp;lt; 7.4% (57 mmol/mol), 7.4-93% (57-78 mmol/mol) and amp;gt;9.3% (78 mmol/mol), there was a higher proportion of females in the highest group during adolescence. In the group with the highest HbA1c values during adolescence and as adults, 51.7% were females, expected value 46.2%; in the group with low HbA1c values in both registries, 34.2% were females, p amp;lt; 0.001. As adults, more females had retinopathy, p amp;lt; 0.05. Females had higher mean HbAlc values at diagnosis, 112 vs. 10.9% (99 vs. 96 mmol/mol), p amp;lt; 0.03, during adolescence, 8.5 vs. 82% (69 vs. 66 mmol/mol) p amp;lt; 0.01, but not as young adults. Conclusions: Worse glycaemic control was found in adolescent females, and they had a higher frequency of microvascular complications. Improved paediatric diabetes care is of great importance for increasing the likelihood of lower mortality and morbidity later in life. (C) 2016 Elsevier Inc. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2016
Keywords
HbA1c; Type 1 diabetes; Gender; Microvascular complications; Quality of care
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:liu:diva-130403 (URN)10.1016/j.jdiacomp.2016.02.007 (DOI)000378759700028 ()27052153 (PubMedID)
Note

Funding Agencies|Association of Local Authorities and Regions, SALAR; Futurum - Academy for Health and Care, Jonkoping County Council, Sweden

Available from: 2016-08-15 Created: 2016-08-05 Last updated: 2017-11-28
Anderzen, J., Samuelsson, U., Gudbjornsdottir, S., Hanberger, L. & Akesson, K. (2016). Teenagers with poor metabolic control already have a higher risk of microvascular complications as young adults. Journal of diabetes and its complications, 30(3), 533-536
Open this publication in new window or tab >>Teenagers with poor metabolic control already have a higher risk of microvascular complications as young adults
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2016 (English)In: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 30, no 3, p. 533-536Article in journal (Refereed) Published
Abstract [en]

Aims: To evaluate how HbA1c in adolescents with type 1 diabetes affects microvascular complications in young adults. Methods: All individuals registered in the Swedish paediatric diabetes quality registry (SWEDIABKIDS) 13-18 years of age, and as adults registered in the Swedish National Diabetes Registry (NDR) in both the years 2011 and 2012 were included, in total 4250 individuals. Results: Of the individuals with mean HbA1c >78 mmol/mol in SWEDIABKIDS 83.4% had retinopathy, 15.8% had microalbuminuria and 4.9% had macroalbuminuria in NDR. The logistic regression analysis showed that the OR to develop macroalbuminuria as a young adult was significantly higher in the group with mean HbA1c >78 mmol/mol in SWEDIABKIDS (p < 0.05). Among the patients with mean HbA1c above 78 mmol/mol in both registries there was a significantly higher proportion that had retinopathy, microalbuminuria (p < 0.001) and/or macroalbuminuria (p < 0.01) compared to the group with HbA1c below 57 mmol/mol in both registries. Only 6.5% of the persons in this study were over 30 years of age. Conclusions: Paediatric diabetes teams working with teenagers must be aware of the impact of good metabolic control during adolescence, and should intensify the care during this vulnerable period of life to reduce the risk of microvascular complications in young adults.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2016
Keywords
Type 1 diabetes; Teenagers; National quality register; Metabolic control; Microvasular complications
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-127423 (URN)10.1016/j.jdiacomp.2015.12.004 (DOI)000372940300024 ()26775554 (PubMedID)
Note

Funding Agencies|Ostergotland County Council; Futurum the Academy for Health and Care; Jonkoping County Council; FORSS- Medical Research Council of Southeast Sweden

Available from: 2016-05-01 Created: 2016-04-26 Last updated: 2017-11-30
Akesson, K., Hanberger, L. & Samuelsson, U. (2015). The influence of age, gender, insulin dose, BMI, and blood pressure on metabolic control in young patients with type 1 diabetes. Pediatric Diabetes, 16(8), 581-586
Open this publication in new window or tab >>The influence of age, gender, insulin dose, BMI, and blood pressure on metabolic control in young patients with type 1 diabetes
2015 (English)In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 16, no 8, p. 581-586Article in journal (Refereed) Published
Abstract [en]

ObjectiveTo explore the relationship between certain clinical variables and metabolic HbA1c at diagnosis correlated to HbA1c at follow-up (p less than 0.001). There was a clear gender difference regarding HbA1c. Girls had higher values both at diagnosis and at follow-up (p less than 0.001). Girls also had lower BMI and pH at diagnosis than boys (p less than 0.001). In contrast, girls with the highest body mass index (BMI) at follow-up had higher mean HbA1c at follow-up in 2010 (p less than 0.001). Having a mother and/or a father with high BMI implied higher HbA1c at diagnosis (p less than 0.003). ConclusionsHbA1c at diagnosis seems to predict metabolic control years later. There is a gender difference at diagnosis as female patients have higher HbA1c than males at diagnosis as well as at follow up. As metabolic control is very much correlated to complications there is a need to early identify patients at risk of poor metabolic control. Even though we do not know whether a high HbA1c level is mainly due to severity of the disease or to behavioral patterns, new ways to treat and support these children, especially girls, are needed.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2015
Keywords
children; gender; HbA1c; metabolic control; quality register; type 1 diabetes
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-123060 (URN)10.1111/pedi.12219 (DOI)000363929400003 ()25270077 (PubMedID)
Note

Funding Agencies|Ostergotland County Council; academy for Health and Care; Jonkoping County Council; Futurum

Available from: 2015-12-04 Created: 2015-12-03 Last updated: 2017-12-01
Petersson, C., Huus, K., Samuelsson, U., Hanberger, L. & Akesson, K. (2015). Use of the national quality registry to monitor health-related quality of life of children with type I diabetes: A pilot study. Journal of Child Health Care, 19(1), 30-42
Open this publication in new window or tab >>Use of the national quality registry to monitor health-related quality of life of children with type I diabetes: A pilot study
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2015 (English)In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 19, no 1, p. 30-42Article in journal (Refereed) Published
Abstract [en]

The management of diabetes is complicated, as treatment affects the everyday life of both children and their families. To enable optimal care for children with type I diabetes, it is important to highlight health-related quality of life (HrQoL) as well as medical outcomes to detect psychological problems that otherwise could be missed. The aim was to study HrQoL in children and adolescents with type I diabetes dependent on gender, age and co-morbidity and to study the consistency between childrens self-reporting and parents proxy reporting. The cross-sectional data were collected using the questionnaire DISABKIDS Chronic Generic Measure and the DISABKIDS diabetes module. Parents in the proxy report perceived their childrens HrQoL to be lower than children themselves. Boys reported their HrQoL to be better than girls. Results show that living with an additional disease has an impact on the HrQoL, which is an important factor to consider in the quality registry. Assessing HrQoL on a routine basis may facilitate detection and discussion of HrQoL-related questions in the national quality registry.

Place, publisher, year, edition, pages
SAGE Publications (UK and US), 2015
Keywords
Assessment; diabetes; paediatric; statistics
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-117244 (URN)10.1177/1367493513496674 (DOI)000351302500004 ()23975719 (PubMedID)
Available from: 2015-04-22 Created: 2015-04-21 Last updated: 2017-12-04
Hanberger, L., Birkebaek, N., Bjarnason, R., Drivvoll, A. K., Johansen, A., Skrivarhaug, T., . . . Samuelsson, U. (2014). Childhood diabetes in the nordic countries: a comparison of quality registries.. Journal of diabetes science and technology, 8(4), 738-44
Open this publication in new window or tab >>Childhood diabetes in the nordic countries: a comparison of quality registries.
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2014 (English)In: Journal of diabetes science and technology, ISSN 1932-2968, Vol. 8, no 4, p. 738-44Article in journal (Refereed) Published
Abstract [en]

In 2008 a Nordic collaboration was established between the quality registries in Denmark, Iceland, Norway, and Sweden to improve quality of care for children with diabetes. This study aimed to describe those registries and confirm that the registry variables are comparable. Selected variables were used to demonstrate outcome measurements. The organization of the registries and methodology are described. Cross-sectional data for patients between birth and 14.9 years with type 1 diabetes mellitus in 2009 (n = 6523) from 89 centers were analyzed. Variables were age, gender, and diabetic ketoacidosis at onset, together with age, gender, HbA1c, insulin regimen, and severe hypoglycemia at follow-up in 2009. All 4 registries use a standardized registration at the onset of diabetes and at follow-up, conducted at the local pediatric diabetes centers. Methods for measuring HbA1c varied as did methods of registration for factors such as hypoglycemia. No differences were found between the outcomes of the clinical variables at onset. Significant variations were found at follow-up for mean HbA1c, the proportion of children with HbA1c < 57 mmol/mol (NGSP/DCCT 7.4%), (range 15-31%), the proportion with insulin pumps (range 34-55%), and the numbers with severe hypoglycemia (range 5.6-8.3/100 patient years). In this large unselected population from 4 Nordic countries, a high proportion did not reach their treatment target, indicating a need to improve the quality of pediatric diabetes care. International collaboration is needed to develop and harmonize quality indicators and offers possibilities to study large geographic populations, identify problems, and share knowledge.

Place, publisher, year, edition, pages
Sage Publications, 2014
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-115300 (URN)10.1177/1932296814531479 (DOI)24876421 (PubMedID)
Available from: 2015-03-12 Created: 2015-03-12 Last updated: 2018-01-11Bibliographically approved
Hanberger, L., Akesson, K. & Samuelsson, U. (2014). Glycated haemoglobin variations in paediatric type 1 diabetes: the impact of season, gender and age. Acta Paediatrica, 103(4), 398-403
Open this publication in new window or tab >>Glycated haemoglobin variations in paediatric type 1 diabetes: the impact of season, gender and age
2014 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 4, p. 398-403Article in journal (Refereed) Published
Abstract [en]

AimTo study whether monthly variations in type 1 diabetes incidence are related to monthly glycated haemoglobin (HbA1c) levels at diagnosis and if high HbA1c at diagnosis is related to certain clinical variables at diagnosis and during the clinical course of the disease. MethodsData from 4430 boys and 3590 girls registered in the Swedish paediatric diabetes quality registry, Swedish paediatric diabetes quality registry, from 2000 to 2010 were analysed. ResultsMonth of onset varied (pless than0.001), with 53% diagnosed during September to February, and mean HbA1c at diagnosis was highest in May (10.9%, 96mmol/mol) and lowest in (October 9.4%, 88mmol/mol) (pless than0.001). Girls showed higher HbA1c at onset than boys (pless than0.001). More than half (53%) with an annual mean HbA1c of greater than9.3% (78mmol/mol) and 4% of those with an annual mean of less than7.4% (57mmol/mol) in 2007 had greater than9.3% (78mmol/mol) in 2010. ConclusionPatients with high HbA1c levels during a certain period have the same high levels several years later. This group, perhaps including those with high HbA1c level at diagnosis, may need more intensive care, including extra support from the diabetes teams and other forms of medical treatment.

Place, publisher, year, edition, pages
Wiley, 2014
Keywords
HbA1c; Metabolic control; Quality register; Seasonal variations; Type 1 diabetes
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-106120 (URN)10.1111/apa.12530 (DOI)000332694700020 ()
Available from: 2014-04-25 Created: 2014-04-24 Last updated: 2017-12-05
Peterson, A., Hanberger, L., Akesson, K., Bojestig, M., Andersson Gare, B. & Samuelsson, U. (2014). Improved Results in Paediatric Diabetes Care Using a Quality Registry in an Improvement Collaborative: A Case Study in Sweden. PLoS ONE, 9(5), e0097875
Open this publication in new window or tab >>Improved Results in Paediatric Diabetes Care Using a Quality Registry in an Improvement Collaborative: A Case Study in Sweden
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2014 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 5, p. e0097875-Article in journal (Refereed) Published
Abstract [en]

Background: Several studies show that good metabolic control is important for children and adolescents with type 1 diabetes. In Sweden, there are large differences in mean haemoglobin A1c (HbA1c) in different hospitals and difficulties implementing national guidelines in everyday practice. This study shows how the participation in an improvement collaborative could facilitate improvements in the quality of care by paediatric diabetes teams. The Swedish paediatric diabetes quality registry, SWEDIABKIDS was used as a tool and resource for feedback and outcome measures. Methods: Twelve teams at paediatric diabetes centres, caring for 30% (2302/7660) of patients in Sweden, participated in an 18-month quality improvement program. Each team defined treatment targets, areas needing improvement, and action plans. The main outcome was the centre patients mean HbA1c levels, but other clinical variables and change concepts were also studied. Data from the previous six months were compared with the first six months after starting the program, and the long-term follow up after another eleven months. Results: All centres reduced mean HbA1c during the second and third periods compared with the first. The mean reduction for all was 3.7 mmol/mol (pless than0.001), compared with non-participating centres who improved their mean HbA1c with 1.7 mmol/mol during the same period. Many of the participating centres reduced the frequency of severe hypoglycaemia and/or ketoacidosis, and five centres reached their goal of ensuring that all patients had some sort of physical activity at least once weekly. Change concepts were, for example, improved guidelines, appointment planning, informing the patients, improving teamwork and active use of the registry, and health promotion activities. Conclusions: By involving paediatric diabetes teams in a quality improvement collaborative together with access to a quality register, the quality of paediatric diabetes care can improve, thereby contributing to a reduced risk of late complications for children and adolescents with diabetes.

Place, publisher, year, edition, pages
Public Library of Science, 2014
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-108804 (URN)10.1371/journal.pone.0097875 (DOI)000336914100025 ()
Available from: 2014-07-07 Created: 2014-07-06 Last updated: 2017-12-05
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