Quality of diabetes management in children and adolescents in Denmark.

AIM

To describe the management of children and adolescents with Type 1 diabetes mellitus in Denmark.

METHODS

Quality indicators with standards of childhood diabetes management were chosen based on international and national guidelines. Data originated from the nation-wide Danish Registry for Childhood Diabetes and two questionnaires: one questionnaire was sent to all children with diabetes (response rate 78%, n=1335) and the other was sent to the 19 centres in Denmark treating these children (response rate 100%). Simultaneously, the children were asked to take a blood sample for central HbA1c-analysis (normal range 4.3-5.8, mean 5.1%).

RESULTS

Most children were managed at centres which complied with the standards for the process indicators for good diabetes management, but not with the standards for most structure and outcome indicators. Only one third of the children reached the treatment target for HbA1c. Their mean HbA1c-level increased gradually from ages 4-14 without significant difference between genders. The youngest children had the lowest HbA1c (mean 8.2%) and the lowest rate of severe hypoglycaemic events (4.6 events per 100 patient years). The subgroup of children without any hypoglycaemic events had the significantly lowest mean HbA1c-level (8.6%, P=0.028).

CONCLUSIONS

The Danish Registry for Childhood Diabetes provided useful data for quality improvement, but had to be supplemented with data from questionnaires on the structure and process indicators. Outcome of paediatric diabetes management in Denmark was unsatisfactory. Centres need feedback on ways to improve care to lower the children's risk of developing severe diabetes complications.