Outcome of Quality Management in Pediatric Diabetes Care

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Abstract
In 1988 and 1990 screening for HbA1c and albumin excretion rate (AER) in diabetic children was carried out throughout Denmark. Each study included about 1,000 diabetic patients and found HbA1c and insulin requirements increased during maturation in both sexes. No significant differences in HbA1c were seen among adolescents treated with two, three or more daily insulin injections. The prevalence of persistent microalbuminuria was 4.3% which was associated only with age and diastolic blood pressure. An international survey on HbA1c and insulin treatment, involving 2,873 children, showed HbA1c to vary significantly between centers. Severe hypoglycemia was related to younger age (0–8 years) and lower HbA1c. Of the children on twice and three times daily injections, 37% used a premixed form of insulin. Very young children were treated with a higher proportion of long-acting insulin. Among adolescent boys, lower HbA1c was related to the use of more short-acting insulin. The data confirm that current treatment of childhood diabetes is inadequate.

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