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Care delivery and outcomes among Belgian children and adolescents with type 1 diabetes

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Doggen, K. Debacker, N. Beckers, Dominique [UCL] Casteels, K. Coeckelberghs, M. Maes, Marc [UCL] Van Casteren, V.

We aimed to investigate care processes and outcomes among children and adolescents with type 1 diabetes treated in hospital-based multidisciplinary paediatric diabetes centres. Our retrospective cross-sectional study among 12 Belgian centres included data from 974 patients with type 1 diabetes, aged 0-18 years. Questionnaires were used to collect data on demographic and clinical characteristics, as well as process of care completion and outcomes of care in 2008. Most patients lived with both biological or adoption parents (77 %) and had at least one parent of Belgian origin (78 %). Nearly all patients (≥95 %) underwent determination of HbA1c and BMI. Screening for retinopathy (55 %) and microalbuminuria (73 %) was less frequent, but rates increased with age and diabetes duration. Median HbA1c was 61 mmol/mol (7.7 %) [interquartile range 54- 68 mmol/mol (7.1-8.4 %)] and increased with age and insulin dose. HbA1c was higher among patients on insulin pump therapy. Median HbA1c significantly differed between centres [from 56 mmol/mol (7.3 %) to 66 mmol/mol (8.2 %)]. Incidence of severe hypoglycaemia was 30 per 100 patient-years. Admissions for ketoacidosis had a rate of 3.2 per 100 patient-years. Patients not living with both biological or adoption parents had higher HbA1c and more admissions for ketoacidosis. Parents' country of origin was not associated with processes and outcomes of care. Conclusion: Outcomes of care ranked well compared to other European countries, while complication screening rates were intermediate. The observed centre variation in HbA1c remained unexplained. Outcomes were associated with family structure, highlighting the continuing need for strategies to cope with this emerging challenge. © Springer-Verlag 2012.

Document type Article de périodique (Journal article)
Access type Accès restreint
Publication date 2012
Language Anglais
Journal information "European Journal of Pediatrics" - Vol. 171, no.11, p. 1679-1685 (2012)
Peer reviewed yes
Publisher Springer ((Germany) Heidelberg)
issn 0340-6199
e-issn 1432-1076
Publication status Publié
Affiliations UCL - (MGD) Service de pédiatrie
UCL - SSS/IREC/EDIN - Pôle d'endocrinologie, diabète et nutrition
UCL - (SLuc) Service d'endocrinologie et diabétologie pédiatrique
UCL - SSS/IREC/PEDI - Pôle de Pédiatrie
Keywords Diabetes care ; Diabetes complications ; HbA1c ; Quality improvement
Links
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Bibliographic reference Doggen, K. ; Debacker, N. ; Beckers, Dominique ; Casteels, K. ; Coeckelberghs, M. ; et. al. Care delivery and outcomes among Belgian children and adolescents with type 1 diabetes. In: European Journal of Pediatrics, Vol. 171, no.11, p. 1679-1685 (2012)
Permanent URL http://hdl.handle.net/2078.1/125022