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

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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 (≥95 %) underwent determination of HbA1c and BMI. Screening for retinopathy (55 %) and microalbuminuria (73 %) was less frequent, but rates increased with age and diabetes duration. Median HbA1c was 61 mmol/mol (7.7 %) [interquartile range 54–68 mmol/mol (7.1–8.4 %)] and increased with age and insulin dose. HbA1c was higher among patients on insulin pump therapy. Median HbA1c 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 HbA1c 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 HbA1c remained unexplained. Outcomes were associated with family structure, highlighting the continuing need for strategies to cope with this emerging challenge.

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Acknowledgments

The authors acknowledge the contributions of T. Barrea and V. Vandooren, RN (Cliniques Universitaires Saint-Luc, Brussels); J.P. Bourguignon, MD, PhD; A. Parent, MD and D. Rocour-Brumioul, MD (CHU Liège); S. Tenoutasse, MD, A. Messaaoui, MD and M.P. Roggemans, RN (Hôpital Universitaire des Enfants Reine Fabiola, Brussels) and M. Jannis and W. Asscherickx, MD (Universitair Ziekenhuis Leuven).

Declaration of competing interests

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Health Services Research Unit, Scientific Institute of Public Health, Rue J. Wytsman 14, 1050, Brussels, Belgium

    K. Doggen, N. Debacker & V. Van Casteren

  2. Université Catholique de Louvain, Cliniques Universitaires de Mont-Godinne, 5530, Yvoir, Belgium

    D. Beckers & T. Mouraux

  3. Universitair Ziekenhuis Leuven, 3000, Leuven, Belgium

    K. Casteels

  4. ZNA Koningin Paola Kinderziekenhuis, 2020, Antwerp, Belgium

    M. Coeckelberghs

  5. Ziekenhuis Maas en Kempen, 3680, Maaseik, Belgium

    L. Dooms

  6. Hôpital Universitaire des Enfants Reine Fabiola, 1020, Brussels, Belgium

    H. Dorchy

  7. CHU Liège, 4000, Liège, Belgium

    M. Lebrethon

  8. Heilig-Hartziekenhuis, 8800, Roeselare, Belgium

    K. Logghe

  9. Cliniques Universitaires Saint-Luc, 1200, Brussels, Belgium

    M. Maes

  10. Jessa Ziekenhuis, 3500, Hasselt, Belgium

    G. Massa

  11. Universitair Ziekenhuis Antwerpen, 2650, Edegem, Belgium

    R. Rooman

  12. Cliniques Saint-Joseph, 4000, Liège, Belgium

    G. Thiry-Counson

  13. Universitair Ziekenhuis Gent, 9000, Ghent, Belgium

    S. Van Aken

  14. Universitair Ziekenhuis Brussel, 1090, Brussels, Belgium

    J. Vanbesien

Authors
  1. K. Doggen
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  2. N. Debacker
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  3. D. Beckers
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  4. K. Casteels
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  5. M. Coeckelberghs
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  6. L. Dooms
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  7. H. Dorchy
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  8. M. Lebrethon
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  9. K. Logghe
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  10. M. Maes
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  11. G. Massa
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  12. T. Mouraux
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  13. R. Rooman
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  14. G. Thiry-Counson
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  15. S. Van Aken
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  16. J. Vanbesien
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  17. V. Van Casteren
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Corresponding author

Correspondence to K. Doggen.

Additional information

At the time of study, N. Debacker and T. Mouraux were affiliated with the Scientific Institute of Public Health and Hôpital Universitaire des Enfants Reine Fabiola, respectively.

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Doggen, K., Debacker, N., Beckers, D. et al. Care delivery and outcomes among Belgian children and adolescents with type 1 diabetes. Eur J Pediatr 171, 1679–1685 (2012). https://doi.org/10.1007/s00431-012-1809-2

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  • DOI: https://doi.org/10.1007/s00431-012-1809-2

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