Department of Pediatrics, Haugesund Hospital, Fonna Health Trust, Haugesund, Norway.
Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway.
Diabetes Care. 2024 Jul 1;47(7):1122-1130. doi: 10.2337/dc24-0086.
To evaluate, from 2013 to 2022, how HbA1c, the incidence of acute complications, and use of diabetes technology changed at the national level in Norway and how glycemic control was associated with use of diabetes technology, carbohydrate counting, or participation in a quality improvement project.
This longitudinal observational study was based on 27,214 annual registrations of 6,775 children from the Norwegian Childhood Diabetes Registry from 2013 to 2022. Individuals aged >18 years, those with diabetes other than type 1, and those without HbA1c measurements were excluded. The outcome measure was HbA1c. The predictor variables in the adjusted linear mixed-effects model were 1) the use of diabetes technology, 2) the use of carbohydrate counting for meal bolusing, and 3) whether the patient's diabetes team participated in a quality improvement project.
Mean HbA1c decreased from 8.2% (2013) to 7.2% (2021), and the proportion of youth reaching an HbA1c <7.0% increased from 13% (2013) to 43% (2022). Insulin pump use increased from 65% (2013) to 91% (2022). Continuous glucose monitoring (CGM) use increased from 34% (first recorded in 2016) to 97% (2022). Insulin pump, CGM, and carbohydrate counting were associated with lower HbA1c and higher achievement of glycemic targets. Girls had a higher mean HbA1c than boys. Mean HbA1c levels were lower in clinics that participated in a quality improvement project for the following 4 years after the project.
Diabetes technology, carbohydrate counting, and systematic quality improvement in pediatric departments led to improved glycemic control.
评估 2013 年至 2022 年期间，挪威全国范围内 HbA1c、急性并发症发生率和糖尿病技术使用情况的变化，以及血糖控制与糖尿病技术使用、碳水化合物计数或参与质量改进项目之间的关系。
本纵向观察性研究基于 2013 年至 2022 年期间来自挪威儿童糖尿病登记处的 6775 名儿童的 27214 项年度登记数据。排除年龄>18 岁、患有 1 型糖尿病以外的糖尿病以及没有 HbA1c 测量值的个体。主要观察指标为 HbA1c。调整后的线性混合效应模型中的预测变量为 1)糖尿病技术的使用，2)用于餐时剂量调整的碳水化合物计数，3)患者的糖尿病团队是否参与质量改进项目。
平均 HbA1c 从 8.2%（2013 年）降至 7.2%（2021 年），达到 HbA1c<7.0%目标的青少年比例从 13%（2013 年）增至 43%（2022 年）。胰岛素泵的使用从 65%（2013 年）增至 91%（2022 年）。连续血糖监测（CGM）的使用从 34%（2016 年首次记录）增至 97%（2022 年）。胰岛素泵、CGM 和碳水化合物计数与较低的 HbA1c 和更高的血糖控制目标实现相关。女孩的平均 HbA1c 高于男孩。参加质量改进项目的诊所，在项目后的 4 年内平均 HbA1c 水平较低。
糖尿病技术、碳水化合物计数以及儿科部门的系统质量改进均能改善血糖控制。
