Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Australia.
Telethon Kids Institute, University of Western Australia, Perth, Australia.
Pediatr Diabetes. 2018 May;19(3):486-492. doi: 10.1111/pedi.12550. Epub 2017 Jun 30.
Pediatric patients diagnosed with type 1 diabetes (T1D) in Western Australia (WA) are managed by a single, specialist multidisciplinary diabetes service based at a central tertiary hospital in the capital city, Perth, which provides outreach care in regional centers.
To investigate the hypothesis that outcomes for a contemporary, population-based pediatric T1D cohort, managed by a single tertiary service are similar for metropolitan and non-metropolitan patients using this model of care. To confirm that the cohort is indeed population based, a secondary aim of the study was to determine the case ascertainment of the Western Australian Children's Diabetes Database (WACDD).
Data for all T1D patients aged <18 years, who attended the diabetes clinics (metropolitan and non-metropolitan), at least once in 2014, were extracted from the WACDD and outcomes including HbA1c and severe hypoglycemia (SH) rates analyzed.
In 2014, a total of 1017 patients (492 females, 525 males) attended the diabetes clinics (54% metropolitan and 46% non-metropolitan). After adjusting for age, sex, diabetes duration, and insulin regimen, region of clinic was not a significant predictor of mean HbA1c or SH rate. The case ascertainment of the WACDD was estimated to be 99.9% complete for children diagnosed with T1D aged <15 years between 2002 and 2012.
This study reports similar glycemic outcomes for patients attending diabetes clinics in metropolitan and non-metropolitan areas of WA, suggesting that a model of care provided as outreach from a specialized diabetes service is effective in achieving equitable glycemic outcomes.
在澳大利亚西部（WA）被诊断患有 1 型糖尿病（T1D）的儿科患者由位于首府珀斯的一家中心三级医院的单一专业多学科糖尿病服务管理，该服务提供区域中心的外展护理。
研究假设，通过单一的三级服务管理的当代基于人群的儿科 T1D 队列的结果对于大都市和非大都市患者使用这种护理模式是否相似。为了确认该队列确实是基于人群的，该研究的次要目的是确定西澳大利亚儿童糖尿病数据库（WACDD）的病例检出率。
从 WACDD 中提取了所有 2014 年至少一次参加糖尿病诊所（大都市和非大都市）的<18 岁的 T1D 患者的数据，并分析了 HbA1c 和严重低血糖（SH）发生率等结果。
2014 年，共有 1017 名患者（492 名女性，525 名男性）参加了糖尿病诊所（54%的大都市和 46%的非大都市）。在校正年龄、性别、糖尿病病程和胰岛素方案后，诊所所在区域不是平均 HbA1c 或 SH 率的显著预测因素。WACDD 的病例检出率估计为 2002 年至 2012 年间<15 岁诊断为 T1D 的儿童为 99.9%完整。
本研究报告了在 WA 大都市和非大都市地区参加糖尿病诊所的患者血糖控制结果相似，表明由专门的糖尿病服务提供的外展护理模式在实现公平的血糖控制结果方面是有效的。
