Improving the outcome for children and adolescents with type 1 diabetes: results of a changing service in Copenhagen

Abstract

In 1995, an international study of HbA 1c levels in 22 centres showed that our centre in Glostrup, Copenhagen, recorded a mean HbA 1c signi®cantly above the average. As a consequence, we instituted a series of changes in the structure and process of our service. During the period from 1995 to 1998 we have closely monitored and evaluated the human and ®nancial resources to optimise outpatient care. We reorganised the work of the medical and paramedical staff to concentrate more on outpatient than on inpatient management, established a 24 hour dedicated telephone hotline and de®ned clear standards of care and criteria for evaluation. In 1993, new rules for the referral system in the Copenhagen area were agreed, resulting in more children being seen at our centre. Consequently, a single, large, centralised children's clinic for Copenhagen was founded at Glostrup. Despite the increased number of children being seen, the changes made have resulted in a reduction in hospital admissions and a fall in mean HbA 1c of approximately 1% across all age groups. This process was facilitated by use of a quality-focused computer program allowing easy data access and surveillance.

Factors associated with glycaemic outcome of childhood diabetes care in Denmark

“…A recent study has demonstrated changes in structure and process at a diabetes centre to be followed by improvement in outcome. These changes included reorganizing the work of the health professionals in the diabetes team and the definition of clear standards of care [32].…”

Continuing Stability of Center Differences in Pediatric Diabetes Care: Do Advances in Diabetes Treatment Improve Outcome?

“…However, the range of changes made suggests that the two centers may have undergone a more fundamental restructuring of care rather than just tinkering with service provision. Increased numbers of diabetes nurses, weekly staff meetings, written patient information, and increased visits may have lead to improved education and/or treatment adherence (17). In comparison, the DCCT/ Epidemiology of Diabetes Interventions and Complications results in adolescents show that in both DCCT intensive and nonintensive groups the mean A1C levels of ϳ8.4% suggest that this age-group requires a fundamentally different approach to obtain a significant improvement in metabolic outcome (18).…”

Quality of diabetes management in children and adolescents in Denmark1

“…Previous studies show that many children and adolescents do not achieve satisfactory blood glucose control [1–4]. Improved blood glucose regulation is associated with a significantly lower risk of developing complications such as nephropathy, retinopathy, and neuropathy [5–7].…”