Center differences in diabetes treatment outcomes among children with type 1 diabetes: A nationwide study of 3866 Danish children.

OBJECTIVE

Mean differences in HbA across centers are well established, but less well understood. The aim was to assess whether differences in patient case-mix can explain the variation in mean HbA between pediatric diabetes centers in Denmark. The association between HbA , frequency of blood glucose monitoring (BGM), treatment modality, and center visits was investigated.

RESEARCH DESIGN AND METHODS

This longitudinal nationwide study included 3866 Danish children with type 1 diabetes from 2013 to 2017 (n = 12,708 child-year observations) from 16 different pediatric diabetes centers. Mean HbA , proportion of children reaching HbA treatment target (HbA  ≤ 58 mmol/mol [7.5%]) were compared across centers using linear regression models. This was done with and without adjustment for socioeconomic characteristics (patient case-mix).

RESULTS

The mean difference in HbA during follow-up was 11.6 mmol/mol (95% CI 7.9, 15.3) (1.1% [95% CI 0.7, 1.4]) when comparing the centers with the lowest versus highest mean HbA . The difference was attenuated and remained significant after adjustment for the patient case-mix (difference: 10.5 mmol/mol [95% CI 6.8, 14.2] (1.0% [95% CI 0.6, 1.3])). Overall, 6.8% of the differences in mean HbA across centers were explained by differences in the patient case-mix. Across centers, more frequent BGM was associated with lower HbA . The proportion of insulin pump users and number of visits was not associated with HbA .

CONCLUSION

In a setting of universal health care, large differences in HbA across centers were found, and could not be explained by patient background, number of visits or use of technology. Only BGM was associated with center HbA .