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  • 1.
    Hanberger, Lena
    et al.
    Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Samuelsson, Ulf
    Division of Paediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Holl, Reinhard W
    Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.
    Fröhlich-Reiterer, Elke
    Department of Pediatrics, Medical University of Graz, Graz, Austria.
    Åkesson, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Division of Paediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Hofer, Sabine
    Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria.
    Type 1 diabetes during adolescence: International comparison between Germany, Austria, and Sweden.2018In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 19, no 3, p. 506-511Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: By using pediatric diabetes quality registries in Austria, Germany, and Sweden treatment of type 1 diabetes and the outcome of care during the vulnerable adolescence period were compared.

    METHODS: Data in DPV, broadly used in Austria and Germany, and Swediabkids used in Sweden, from clinical visits in the year 2013 on 14 383 patients aged 11 to 16 years regarding hemoglobin A1c (HbA1c), insulin regimen, body mass index (BMI)-SD score (SDS), blood pressure, hypoglycemia, ketoacidosis, and smoking habits were analyzed.

    RESULTS: Patients in Sweden had fewer clinical visits per year (P < .05), lower insulin dose per kg (P < .001), and lower proportion of fast acting insulin compared with Germany and Austria (P < .001). The proportion of pump users was higher in Sweden (P < .001). Patients in Sweden had lower mean HbA1c levels (Austria: 64 mmol/mol, Germany: 63 mmol/mol, and Sweden: 61 mmol/mol [8.0%, 7.9%, and 7.7%, respectively]; P < .001). The frequency of severe hypoglycemia was higher in Sweden while it was lower for ketoacidosis (3.3% and 1.1%, respectively) than in Austria (1.1% and 5.3%) and Germany (2.0% and 4.4%) (P < .001). Girls in all 3 countries had higher HbA1c and BMI-SDS than boys.

    CONCLUSIONS: Sharing data between diabetes registries and nations enables us to better understand differences in diabetes outcome between countries. In this particular comparison, pediatric patients with diabetes in Sweden were more often treated with insulin pump, had lower HbA1c levels and a higher rate of severe hypoglycemia. Patients in Austria and Germany used rapid acting insulin analogs more often and had a lower rate of ketoacidosis.

  • 2. Jonson, CO
    et al.
    Lernmark, Å
    Ludvigsson,
    Rutledge, EA
    Hinkkanen, A
    Faresjö, Maria
    Hälsouniversitet i Linköping.
    The importance of CTLA-4 polymorphism and human leukocyte antigen genotype for the induction of diabetes-associated cytokine response in healthy school children2007In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 8, no 4, p. 185-192Article in journal (Refereed)
  • 3.
    Nilsson, John
    et al.
    Department of Paediatrics, Ryhov County Hospital, Jönköping, Sweden.
    Åkesson, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Futurum—Academy for Health and Care, Jönköping County Council .
    Hanberger, Lena
    Department of Medicine and Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden.
    Samuelsson, Ulf
    Department of Clinical and Experimental Medicine, Division of Paediatrics and Diabetes Research Centre, Linköping University Hospital, Linköping, Sweden.
    High HbA1c at onset cannot be used as a predictor for future metabolic control for the individual child with type 1 diabetes mellitus.2017In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 18, no 8, p. 848-852Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To study how metabolic control at onset of type 1 diabetes correlates to metabolic control and clinical parameters during childhood until transition from pediatric care to adult diabetes care.

    MATERIALS AND METHODS: Data at onset, three months, one, three, and five years after diagnosis and at transition, on HbA1c and clinical parameters, on 8084 patients in the Swedish pediatric quality registry, SWEDIABKIDS, were used. Of these patients, 26% had been referred to adult diabetes care by 2014.

    RESULTS: Children with HbA1c < 72 mmol/mol (8.7%) (20% of patients, low group) at diagnosis continued to have good metabolic control during childhood, in contrast to children with HbA1c > 114 mmol/mol (12.6%) (20% of patients, high group) at diagnosis, who continued to have high HbA1c at follow-up. For the individual, there was no significant correlation between high HbA1c at onset and during follow-up. During follow-up, children in the high group were more often smokers, less physically active, and more often had retinopathy than children in the low group (P < .01, .01, .03 respectively).

    CONCLUSION: High HbA1c at onset was associated with high HbA1c during follow-up on a group level, but it cannot be used as a predictor of future metabolic control on an individual level. These results emphasize the important work done by the diabetes team in the first years after diagnosis. It is important to continuously set high goals for the achievement of tight metabolic control, in order to decrease the risk of microvascular complications.

  • 4.
    Samuelsson, U.
    et al.
    Department of Clinical and Experimental Medicine, Division of Paediatrics and Diabetes, Research Centre, Linköping University, Linköping, Sweden.
    Westerberg, L.
    IFM Biology, Linköping University, Linköping, Sweden.
    Åkesson, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Pediatrics, County Hospital Ryhov, Jönköping, Sweden.
    Birkebæk, N. H.
    Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
    Bjarnason, R.
    Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Drivvoll, A. K.
    Norwegian Childhood Diabetes Registry, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Skrivarhaug, T.
    Norwegian Childhood Diabetes Registry, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Svensson, J.
    Herlev University Hospital, CPH-Direct, Pediatric Department, Herlev, Denmark & University of Copenhagen, Faculty of Health and Medical Science, Copenhagen, Denmark.
    Thorsson, A.
    Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Hanberger, L.
    Department of Medicine and Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden.
    Geographical variation in the incidence of type 1 diabetes in the Nordic countries: A study within NordicDiabKids2019In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448Article in journal (Refereed)
    Abstract [en]

    Background: The incidence of type 1 diabetes (T1D) is high in the Nordic countries with geographic differences between as well as within countries. Objective: To describe the geographical distribution of the incidence of T1D among children in four Nordic countries, an area where the population is considered genetically similar. Methods: Data on children 0 to 14 years of age and diagnosed with T1D 2006 to 2011 was collected from four Nordic national pediatric quality diabetes registries. Data included year of diagnosis (2006-2011), sex, and age at diagnosis. Figures for number of children at risk during 2006 to 2011—as well as total population, proportion with foreign background and size of populated areas of geographic regions—were collected from official statistics. Results: The total incidence during the study period for all four countries was 35.7/100 000 person years but differed between the countries (range 18.2-44.1; P <.001). The incidence difference between the countries was most obvious in the highest age group, 10 to 14 years of age, whereas there was no difference in the youngest age group 0 to 5 years of age. Iceland had similar incidence in the entire country, whereas the other countries had areas with different incidence. Densely populated areas, such as major cities, had the lowest incidence. Conclusion: The incidence of T1D differed between the Nordic countries and also between the neighboring countries and generally decreased with population density. This indicates that environmental factors may contribute to the level of incidence of T1D.

  • 5.
    Samuelsson, Ulf
    et al.
    Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Sweden.
    Åkesson, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Pediatrics, County Hospital Ryhov, Jönköping, Sweden.
    Peterson, Anette
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Hanås, Ragnar
    The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Sweden.
    Hanberger, Lena
    Division of Nursing, Department of Medicine and Health Sciences, Linköping University, Sweden.
    Continued improvement of metabolic control in Swedish pediatric diabetes care.2018In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 19, no 1, p. 150-157Article in journal (Refereed)
    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.

  • 6. Vrabelova, Z
    et al.
    Kolouskova, S
    Böhmova, K
    Karlsson Faresjö, Maria
    Hälsouniversitetet i Linköping.
    Sumnik, Z
    Pechova, M
    Kverka, M
    Chudoba, D
    Zacharovova, K
    Stadlerova, G
    Pithova, P
    Hladikova, M
    Stechova, K
    Protein microarray analysis as a tool for monitoring cellular autoreactivity in type 1 diabetes patients and their relatives2007In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 8, no 5, p. 252-260Article in journal (Refereed)
  • 7.
    Åkesson, Karin
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Ryhov City Hospital, Jönköping.
    Hanberger, Lena
    Linköping University Hospital.
    Samuelsson, Ulf
    Linköping University Hospital.
    The influence of age, gender, insulin dose, BMI, and blood pressure on metabolic control in young patients with type 1 diabetes2015In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 16, no 8, p. 581-586Article in journal (Refereed)
    Abstract [en]

    Objective

    To explore the relationship between certain clinical variables and metabolic HbA1c at diagnosis correlated to HbA1c at follow-up (p < 0.001). There was a clear gender difference regarding HbA1c. Girls had higher values both at diagnosis and at follow-up (p < 0.001). Girls also had lower BMI and pH at diagnosis than boys (p < 0.001). In contrast, girls with the highest body mass index (BMI) at follow-up had higher mean HbA1c at follow-up in 2010 (p < 0.001). Having a mother and/or a father with high BMI implied higher HbA1c at diagnosis (p < 0.003).

    Conclusions

    HbA1c at diagnosis seems to predict metabolic control years later. There is a gender difference at diagnosis as female patients have higher HbA1c than males at diagnosis as well as at follow up. As metabolic control is very much correlated to complications there is a need to early identify patients at risk of poor metabolic control. Even though we do not know whether a high HbA1c level is mainly due to severity of the disease or to behavioral patterns, new ways to treat and support these children, especially girls, are needed.

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