The Hvidøre Study Group on Childhood Diabetes

Persistent center differences over 3 years in glycemic

control and hypoglycemia in a study of 3,805 children and

adolescents with type 1 diabetes from the Hvidøre

Study Group

Persistent center differences over 3 years in glycemic

control and hypoglycemia in a study of 3,805 children and

adolescents with type 1 diabetes from the Hvidøre

Study GroupHvidøre Study Group on Childhood Diabetes

The Hvidøre Study Group on Childhood Diabetes

T. Danne1, H.B. Mortensen2, P. Hougaard3, H. Lynggaard3 , H.-J. Aanstoot4, F. Chiarelli5 , D. Daneman6 , H. Dorchy7, P. Garandeau8, S.A. Greene9, H. Hoey10, R.W. Holl11, E.A. Kaprio12, M. Kocova13, P. Martul14, N. Matsuura15, K.J. Robertson16, E.J. Schoenle17, O. Søvik18, P.G.F. Swift19, R.M. Tsou20, M. Vanelli21, J. Aman22

1 Charité Children’s Hospital, Humboldt University, Berlin, Germany2 Glostrup University Hospital, Glostrup, Denmark3 Novo Nordisk A/S, Denmark4 Sophia Children’s Hospital, Rotterdam, The Netherlands5 Pediatric University Clinic, Chieti, Italy6 The Hospital for Sick Children, University of Toronto, Toronto, Canada7 University Children´s Hospital ”Reine Fabiola”, Brussels, Belgium8 Institut St. Pierre, Montpellier, France9 Ninewells Hospital, Dundee/U.K.10 University of Dublin, Trinity College, National Children's Hospital,Ireland11 Ulm University, Ulm, Germany12 Peijas Hospital, Vantaa/Finland13 University Pediatric Clinic, Skopje, Republic of Macedonia14 Hospital de Cruces, Baracaldo, Spain15 Kitasato University School of Medicine, Kanagwa, Japan16 Royal Hospital for Sick Children, Glasgow, UK17 University Childrens Hospital, Zurich, Switzerland18 Haukeland Hospital, Bergen, Norway19 Leicester Royal Infirmary Children’s Hospital, Leicester, U.K.20 Hospital S. Joao, Pediatric Department, Porto, Portugal21 Pediatric Clinic of Parma University, Parma, Italy22 Örebro Regional Hospital, Örebro, Sweden

The Hvidøre Study Group on Childhood DiabetesThe Hvidøre Study Group on Childhood Diabetes

Study DesignStudy Design 21 departments from 17 countries21 departments from 17 countries 2 sampling periods:2 sampling periods:

1995 N=2,780 (0-18 yrs)1995 N=2,780 (0-18 yrs) 1998 N= 2,101 (11-18ys)1998 N= 2,101 (11-18ys)

HbAHbA1c1c was analysed centrally was analysed centrally 4,835 measurements in 3,805 patients4,835 measurements in 3,805 patients

Age, sex, DM duration, height, weight, Age, sex, DM duration, height, weight, insulin regimen, severe hypoglycaemia insulin regimen, severe hypoglycaemia status were recordedstatus were recorded

The Hvidøre Study Group on Childhood Diabetes

Clinical dataClinical data 19951995 1998 1998

Total NTotal N 2780 2780 2101 2101

Males / FemalesMales / Females 1404 / 13761404 / 1376 1085 / 10161085 / 1016

Age (years)Age (years) 11.97 11.97 4.02 4.02 13.81 13.81 2.12 2.12

Duration (years)Duration (years) 4.78 4.78 3.70 3.70 5.23 5.23 3.79 3.79

BMI (kg/m²)BMI (kg/m²) 19.67 19.67 3.39 3.39 21.28 21.28 3.46 3.46

HbA1c (%)HbA1c (%) 8.62 8.62 1.64 1.64 8.74 8.74 1.66 1.66

Insulin Dose (U/kg) 0.85 Insulin Dose (U/kg) 0.85 0.29 0.29 0.98 0.98 0.32 0.32

The Hvidøre Study Group on Childhood Diabetes

Center differences in glycemic control in 1995Center differences in glycemic control in 1995

7

8

9

10

11baseline mean adjusted HbA1c (%) (%)

center rank at baseline baseline

1 2 3 4 5 6 7 8 9 101112131415161718192021

Mean HbA1c (adjusted for age, gender, diabetes duration):Mean HbA1c (adjusted for age, gender, diabetes duration):8.62 ± 0.03 %8.62 ± 0.03 %

The Hvidøre Study Group on Childhood Diabetes

Center differences are a reproducible Center differences are a reproducible findingfindingCenter differences are a reproducible Center differences are a reproducible findingfinding

2121

8 8 „good“„good“

7 7 „average“„average“

6 6 „poor“„poor“

14 14 unchangedunchanged

1 „good“1 „good“

1 „poor“1 „poor“

19951995 19981998

The Hvidøre Study Group on Childhood Diabetes

7actual change of mean adjusted HbA1c (%) in 3ys

8

9

10

11

baseline mean adjusted HbA1c (%) (%)

-1

-0.5

0

0.5

1

center rank at baseline baseline

** *

*

* **

1 2 3 4 5 6 7 8 9 1011 12 13 14 1516 17 18 19 2021

Changes in glycemic control from 1995 to 98Changes in glycemic control from 1995 to 98

* significant change from baseline (p<0.05)

The Hvidøre Study Group on Childhood Diabetes

center rank at baseline baseline1 2 3 4 5 6 7 8 9 1011 12 13 14 1516 17 18 19 2021

Changes from 1995 to ´98Changes from 1995 to ´98

-2-1012

-0.50

0.51

-0.2-0.1

00.10.2

* * * * * * * * ** * * * * * * *

* * * * * ** * * * *

* * * * * ** * * **

change of adjusted BMI (kg/m²)

change of adjusted number of insulin injections per day

change of adjusted insulin dose(U/kg)

*

* significant change from baseline (p<0.05)

The Hvidøre Study Group on Childhood Diabetes

181614121086420

1.2

1.1

1.0

0.9

0.8

0.7

0.6

0.5

below below averageaverageaveraaveragegeabove above averageaverage

Age (years)

Insu

lin d

ose

(U

/kg

)

No differences in the daily insulin dose between good, average and poor centers

No differences in the daily insulin dose between good, average and poor centers

The Hvidøre Study Group on Childhood Diabetes

Good centers have better glycaemic control in short- and longterm patients

Good centers have better glycaemic control in short- and longterm patients

mean HbA1c of patients with diabetes duration < 3 ys8 9 10 11

7

8

9

10

11m

ean

Hb

A1

c of

pati

en

ts w

ith

ad

iab

ete

s d

ura

tion

>

3ys

7

19951995 R=0.83 p<0.001 R=0.83 p<0.00119981998 R=0.77 p<0.001 R=0.77 p<0.001

The Hvidøre Study Group on Childhood Diabetes

Rate of Severe Hypoglycemia According to the Poisson Model

Age (13 years), Duration (5 years)

Inci

dence

per

100 p

ati

ent

years

20

15

10

5

0 5 6 7 8 9 10 11 12 13 14 15

Individual HbA1c (%)

above

Centers in 1998 significant:

Centers not sign. different:

below

the mean

The Hvidøre Study Group on Childhood Diabetes

The 1995-1998 difference in The 1995-1998 difference in glycemic control for the 7 centers glycemic control for the 7 centers could could notnot be explained by be explained by

prevailing insulin regimens, prevailing insulin regimens, rates of hypoglycaemia or rates of hypoglycaemia or structural aspects of diabetes carestructural aspects of diabetes care

ConclusionsConclusionsConclusionsConclusions