Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Diabetes Technol Ther. 2022 Sep;24(9):628-634. doi: 10.1089/dia.2022.0095.
The German/Austrian Diabetes Patient Follow-up Registry (Diabetes-Patienten-Verlaufsdokumentation or DPV), England/Wales National Pediatric Diabetes Audit (NPDA), and Type 1 Diabetes Exchange (T1DX) in the United States investigated changes in hemoglobin A1c (HbA1c) and diabetes technology use from 2010 to 2018. Registry/audit data from 2010 to 2018 were analyzed in annual cohorts using linear regression for those <18 years of age with type 1 diabetes diagnosed at age >6 months. Time trends in HbA1c, pump, and continuous glucose monitoring (CGM) use were studied using repeated measurements linear and logistic regression models with an autoregressive covariance structure and with year and data source as independent variables. A total of 1,172,980 visits among 114,264 (54,119 DPV, 43,550 NPDA, 16,595 T1DX) patients were identified. HbA1c remained clinically stable in DPV (7.7% [61 mmol/mol] to 7.6% [60 mmol/mol]), decreased in the NPDA (8.7% [72 mmol/mol] to 7.9% [63 mmol/mol]), and increased in T1DX (8.0% [64 mmol/mol] to 8.5% [69 mmol/mol] from 2010 to 2018). In all registries/audits, insulin pump and CGM use increased over time with greatest pump use in T1DX and lowest uptake reported in NPDA. These data reveal three different longitudinal patterns of change in registry/audit HbA1c from 2010 to 2018. Diabetes technology use increased throughout, at different rates. Quality improvement (QI) programs in DPV have been ongoing for 25 years, began in NPDA in 2009 and T1DX in 2016. We speculate that in England/Wales, development of networks, peer review, and implementation of QI measures contributed to reductions in population HbA1c. Many of these interventions had been implemented in DPV before 2010. Further efforts to understand this improvement, including the role of QI, and continued success within standardized documentation and benchmarking could inform T1DX programs to reduce HbA1c.
德国/奥地利糖尿病患者随访登记处（Diabetes-Patienten-Verlaufsdokumentation 或 DPV）、英国/威尔士国家儿科糖尿病审计（NPDA）和美国的 1 型糖尿病交换（T1DX）调查了 2010 年至 2018 年期间糖化血红蛋白（HbA1c）和糖尿病技术使用的变化。对 2010 年至 2018 年的登记/审计数据进行了分析，对年龄大于 6 个月的 1 型糖尿病患者进行了线性回归分析，对年龄小于 18 岁的患者进行了线性回归分析。使用重复测量线性和逻辑回归模型以及自回归协方差结构，研究了 HbA1c、泵和连续血糖监测（CGM）使用的时间趋势，并将年份和数据源作为自变量。共确定了 114264 名患者（54119 名 DPV、43550 名 NPDA、16595 名 T1DX）的 1172980 次就诊。DPV 中的 HbA1c 保持临床稳定（7.7%[61mmol/mol]至 7.6%[60mmol/mol]），NPDA 中 HbA1c 下降（8.7%[72mmol/mol]至 7.9%[63mmol/mol]），T1DX 中 HbA1c 升高（8.0%[64mmol/mol]至 8.5%[69mmol/mol]）。在所有登记处/审计中，胰岛素泵和 CGM 的使用随着时间的推移而增加，T1DX 的泵使用最多，NPDA 的使用率最低。这些数据显示了 2010 年至 2018 年期间，HbA1c 在登记处/审计中的三个不同的纵向变化模式。糖尿病技术的使用随着时间的推移而增加，速度不同。DPV 的质量改进（QI）项目已经进行了 25 年，NPDA 于 2009 年开始，T1DX 于 2016 年开始。我们推测，在英格兰/威尔士，网络的发展、同行评审以及 QI 措施的实施有助于降低人群 HbA1c。其中许多干预措施在 2010 年之前已经在 DPV 中实施。进一步努力了解这一改善，包括 QI 的作用，以及在标准化文件记录和基准方面的持续成功，可以为 T1DX 项目提供信息，以降低 HbA1c。
