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Care delivery and outcomes among Belgian children and adolescents with type 1 diabetes

(2012) EUROPEAN JOURNAL OF PEDIATRICS. 171(11). p.1679-1685
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Abstract
We aimed to investigate care processes and outcomes among children and adolescents with type 1 diabetes treated in hospital-based multidisciplinary paediatric diabetes centres. Our retrospective cross-sectional study among 12 Belgian centres included data from 974 patients with type 1 diabetes, aged 0-18 years. Questionnaires were used to collect data on demographic and clinical characteristics, as well as process of care completion and outcomes of care in 2008. Most patients lived with both biological or adoption parents (77 %) and had at least one parent of Belgian origin (78 %). Nearly all patients (a parts per thousand yen95 %) underwent determination of HbA(1c) and BMI. Screening for retinopathy (55 %) and microalbuminuria (73 %) was less frequent, but rates increased with age and diabetes duration. Median HbA(1c) was 61 mmol/mol (7.7 %) [interquartile range 54-68 mmol/mol (7.1-8.4 %)] and increased with age and insulin dose. HbA(1c) was higher among patients on insulin pump therapy. Median HbA(1c) significantly differed between centres [from 56 mmol/mol (7.3 %) to 66 mmol/mol (8.2 %)]. Incidence of severe hypoglycaemia was 30 per 100 patient-years. Admissions for ketoacidosis had a rate of 3.2 per 100 patient-years. Patients not living with both biological or adoption parents had higher HbA(1c) and more admissions for ketoacidosis. Parents' country of origin was not associated with processes and outcomes of care. Conclusion: Outcomes of care ranked well compared to other European countries, while complication screening rates were intermediate. The observed centre variation in HbA(1c) remained unexplained. Outcomes were associated with family structure, highlighting the continuing need for strategies to cope with this emerging challenge.
Keywords
QUALITY, Diabetes complications, DIABETES, CHILDREN, CENTERS, TYPE 1, EXPERIENCE, METABOLIC-CONTROL, GLYCEMIC CONTROL, Quality improvement, HbA(1c), Diabetes care

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MLA
Doggen, K., et al. “Care Delivery and Outcomes among Belgian Children and Adolescents with Type 1 Diabetes.” EUROPEAN JOURNAL OF PEDIATRICS, vol. 171, no. 11, 2012, pp. 1679–85, doi:10.1007/s00431-012-1809-2.
APA
Doggen, K., Debacker, N., Beckers, D., Casteels, K., Coeckelberghs, M., Dooms, L., … Van Casteren, V. (2012). Care delivery and outcomes among Belgian children and adolescents with type 1 diabetes. EUROPEAN JOURNAL OF PEDIATRICS, 171(11), 1679–1685. https://doi.org/10.1007/s00431-012-1809-2
Chicago author-date
Doggen, K, Noëmi Debacker, D Beckers, K Casteels, M Coeckelberghs, L Dooms, H Dorchy, et al. 2012. “Care Delivery and Outcomes among Belgian Children and Adolescents with Type 1 Diabetes.” EUROPEAN JOURNAL OF PEDIATRICS 171 (11): 1679–85. https://doi.org/10.1007/s00431-012-1809-2.
Chicago author-date (all authors)
Doggen, K, Noëmi Debacker, D Beckers, K Casteels, M Coeckelberghs, L Dooms, H Dorchy, M Lebrethon, K Logghe, M Maes, G Massa, T Mouraux, R Rooman, G Thiry-Counson, Sara Van Aken, J Vanbesien, and V Van Casteren. 2012. “Care Delivery and Outcomes among Belgian Children and Adolescents with Type 1 Diabetes.” EUROPEAN JOURNAL OF PEDIATRICS 171 (11): 1679–1685. doi:10.1007/s00431-012-1809-2.
Vancouver
1.
Doggen K, Debacker N, Beckers D, Casteels K, Coeckelberghs M, Dooms L, et al. Care delivery and outcomes among Belgian children and adolescents with type 1 diabetes. EUROPEAN JOURNAL OF PEDIATRICS. 2012;171(11):1679–85.
IEEE
[1]
K. Doggen et al., “Care delivery and outcomes among Belgian children and adolescents with type 1 diabetes,” EUROPEAN JOURNAL OF PEDIATRICS, vol. 171, no. 11, pp. 1679–1685, 2012.
@article{3195931,
  abstract     = {{We aimed to investigate care processes and outcomes among children and adolescents with type 1 diabetes treated in hospital-based multidisciplinary paediatric diabetes centres. Our retrospective cross-sectional study among 12 Belgian centres included data from 974 patients with type 1 diabetes, aged 0-18 years. Questionnaires were used to collect data on demographic and clinical characteristics, as well as process of care completion and outcomes of care in 2008. Most patients lived with both biological or adoption parents (77 %) and had at least one parent of Belgian origin (78 %). Nearly all patients (a parts per thousand yen95 %) underwent determination of HbA(1c) and BMI. Screening for retinopathy (55 %) and microalbuminuria (73 %) was less frequent, but rates increased with age and diabetes duration. Median HbA(1c) was 61 mmol/mol (7.7 %) [interquartile range 54-68 mmol/mol (7.1-8.4 %)] and increased with age and insulin dose. HbA(1c) was higher among patients on insulin pump therapy. Median HbA(1c) significantly differed between centres [from 56 mmol/mol (7.3 %) to 66 mmol/mol (8.2 %)]. Incidence of severe hypoglycaemia was 30 per 100 patient-years. Admissions for ketoacidosis had a rate of 3.2 per 100 patient-years. Patients not living with both biological or adoption parents had higher HbA(1c) and more admissions for ketoacidosis. Parents' country of origin was not associated with processes and outcomes of care. Conclusion: Outcomes of care ranked well compared to other European countries, while complication screening rates were intermediate. The observed centre variation in HbA(1c) remained unexplained. Outcomes were associated with family structure, highlighting the continuing need for strategies to cope with this emerging challenge.}},
  author       = {{Doggen, K and Debacker, Noëmi and Beckers, D and Casteels, K and Coeckelberghs, M and Dooms, L and Dorchy, H and Lebrethon, M and Logghe, K and Maes, M and Massa, G and Mouraux, T and Rooman, R and Thiry-Counson, G and Van Aken, Sara and Vanbesien, J and Van Casteren, V}},
  issn         = {{0340-6199}},
  journal      = {{EUROPEAN JOURNAL OF PEDIATRICS}},
  keywords     = {{QUALITY,Diabetes complications,DIABETES,CHILDREN,CENTERS,TYPE 1,EXPERIENCE,METABOLIC-CONTROL,GLYCEMIC CONTROL,Quality improvement,HbA(1c),Diabetes care}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{1679--1685}},
  title        = {{Care delivery and outcomes among Belgian children and adolescents with type 1 diabetes}},
  url          = {{http://doi.org/10.1007/s00431-012-1809-2}},
  volume       = {{171}},
  year         = {{2012}},
}

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