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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
UCL, England.
Ulm Univ, Germany; German Ctr Diabet Res DZD, Germany.
Herlev Univ Hosp, Denmark.
Oslo Univ Hosp, Norway.
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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. Vol. 41, no 6, p. 1180-1187
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Public Health, Global Health, Social Medicine and Epidemiology
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URN: urn:nbn:se:liu:diva-148378DOI: 10.2337/dc17-2271ISI: 000432673000023PubMedID: 29650804OAI: oai:DiVA.org:liu-148378DiVA, id: diva2:1219032
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

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Hanberger, Lena

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Åkesson, KarinHanberger, Lena
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Division of Children's and Women's healthFaculty of Medicine and Health SciencesDivision of Nursing ScienceH.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus
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Public Health, Global Health, Social Medicine and Epidemiology

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