Continued improvement of metabolic control in Swedish pediatric diabetes care.Show others and affiliations
2018 (English)In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 19, no 1, p. 150-157Article in journal (Refereed) Published
Abstract [en]
BACKGROUND: To prospectively investigate if the grand mean HbA1c and the differences in mean HbA1c between centers in Sweden could be reduced, thereby improving care delivered by pediatric diabetes teams.
METHODS: We used an 18-month quality improvement collaborative (QIC) together with the Swedish pediatric diabetes quality registry (SWEDIABKIDS). The first program (IQ-1), started in April 2011 and the second (IQ-2) in April 2012; together they encompassed 70% of Swedish children and adolescents with diabetes.
RESULTS: The proportion of patients in IQ-1 with a mean HbA1c <7.4% (57 mmol/mol) increased from 26.4% before start to 35.9% at 36 months (P < .001), and from 30.2% to 37.2% (P < .001) for IQ-2. Mean HbA1c decreased in both participating and non-participating (NP) centers in Sweden, thereby indicating an improvement by a spatial spill over effect in NP centers. The grand mean HbA1c decreased by 0.45% (4.9 mmol/mol) during 36 months; at the end of 2014 it was 7.43% (57.7 mmol/mol) (P < .001). A linear regression model with the difference in HbA1c before start and second follow-up as dependent variable showed that QIC participation significantly decreased mean HbA1c both for IQ-1 and IQ-2. The proportion of patients with high HbA1c values (>8.7%, 72 mmol/mol) decreased significantly in both QICs, while it increased in the NP group.
CONCLUSIONS: The grand mean HbA1c has decreased significantly in Sweden from 2010 to 2014, and QICs have contributed significantly to this decrease. There seems to be a spatial spill-over effect in NP centers.
Place, publisher, year, edition, pages
John Wiley & Sons, 2018. Vol. 19, no 1, p. 150-157
Keywords [en]
diabetes mellitus type 1, hemoglobin A1c protein, human, pediatrics, quality of health care
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:hj:diva-38825DOI: 10.1111/pedi.12467ISI: 000423397600021PubMedID: 27807917Scopus ID: 2-s2.0-84996848900OAI: oai:DiVA.org:hj-38825DiVA, id: diva2:1182391
2018-02-132018-02-132023-08-23Bibliographically approved