改善儿童糖尿病护理中血糖控制的十年:挪威儿童糖尿病登记数据

IF 14.8 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes Care Pub Date : 2024-04-22 DOI:10.2337/dc24-0086
Heiko Bratke, Eva Biringer, Anastasia Ushakova, Hanna D. Margeirsdottir, Siv Janne Kummernes, Pål R. Njølstad, Torild Skrivarhaug
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引用次数: 0

摘要

目的 评估 2013 年至 2022 年挪威全国 HbA1c、急性并发症发病率和糖尿病技术使用情况的变化,以及血糖控制与糖尿病技术使用、碳水化合物计数或参与质量改进项目的关系。研究设计与方法 这项纵向观察研究基于2013年至2022年期间挪威儿童糖尿病登记处对6775名儿童进行的27214次年度登记。研究对象不包括年龄在18岁以下的儿童、1型糖尿病以外的糖尿病患者以及未进行HbA1c测量的儿童。结果指标为 HbA1c。调整后线性混合效应模型的预测变量为:1)糖尿病技术的使用情况;2)使用碳水化合物计数法进餐;3)患者所在的糖尿病团队是否参与了质量改进项目。结果 平均 HbA1c 从 8.2%(2013 年)降至 7.2%(2021 年),HbA1c <7.0% 的青少年比例从 13%(2013 年)增至 43%(2022 年)。胰岛素泵的使用率从 65%(2013 年)增至 91%(2022 年)。连续葡萄糖监测(CGM)的使用率从 34%(2016 年首次记录)增至 97%(2022 年)。胰岛素泵、CGM 和碳水化合物计数与较低的 HbA1c 和较高的血糖目标实现率相关。女孩的 HbA1c 平均值高于男孩。参与质量改进项目的诊所在项目结束后的 4 年中平均 HbA1c 水平较低。结论 儿科采用糖尿病技术、碳水化合物计数和系统性质量改进可改善血糖控制。
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Ten Years of Improving Glycemic Control in Pediatric Diabetes Care: Data From the Norwegian Childhood Diabetes Registry
OBJECTIVE To evaluate, from 2013 to 2022, how HbA1c, the incidence of acute complications, and use of diabetes technology changed at the national level in Norway and how glycemic control was associated with use of diabetes technology, carbohydrate counting, or participation in a quality improvement project. RESEARCH DESIGN AND METHODS This longitudinal observational study was based on 27,214 annual registrations of 6,775 children from the Norwegian Childhood Diabetes Registry from 2013 to 2022. Individuals aged >18 years, those with diabetes other than type 1, and those without HbA1c measurements were excluded. The outcome measure was HbA1c. The predictor variables in the adjusted linear mixed-effects model were 1) the use of diabetes technology, 2) the use of carbohydrate counting for meal bolusing, and 3) whether the patient’s diabetes team participated in a quality improvement project. RESULTS Mean HbA1c decreased from 8.2% (2013) to 7.2% (2021), and the proportion of youth reaching an HbA1c <7.0% increased from 13% (2013) to 43% (2022). Insulin pump use increased from 65% (2013) to 91% (2022). Continuous glucose monitoring (CGM) use increased from 34% (first recorded in 2016) to 97% (2022). Insulin pump, CGM, and carbohydrate counting were associated with lower HbA1c and higher achievement of glycemic targets. Girls had a higher mean HbA1c than boys. Mean HbA1c levels were lower in clinics that participated in a quality improvement project for the following 4 years after the project. CONCLUSIONS Diabetes technology, carbohydrate counting, and systematic quality improvement in pediatric departments led to improved glycemic control.
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来源期刊
Diabetes Care
Diabetes Care 医学-内分泌学与代谢
CiteScore
27.80
自引率
4.90%
发文量
449
审稿时长
1 months
期刊介绍: The journal's overarching mission can be captured by the simple word "Care," reflecting its commitment to enhancing patient well-being. Diabetes Care aims to support better patient care by addressing the comprehensive needs of healthcare professionals dedicated to managing diabetes. Diabetes Care serves as a valuable resource for healthcare practitioners, aiming to advance knowledge, foster research, and improve diabetes management. The journal publishes original research across various categories, including Clinical Care, Education, Nutrition, Psychosocial Research, Epidemiology, Health Services Research, Emerging Treatments and Technologies, Pathophysiology, Complications, and Cardiovascular and Metabolic Risk. Additionally, Diabetes Care features ADA statements, consensus reports, review articles, letters to the editor, and health/medical news, appealing to a diverse audience of physicians, researchers, psychologists, educators, and other healthcare professionals.
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