NEW PUBLICATION How can we improve care for children with diabetes in Norway ?

This study shows that guidelines and the establishment of a system for nationwide anonymous comparison  between treatment centres of quality indicators for childhood diabetes  lead to improvement in diabetes care.

Data were collected prospectively yearly according to standardized written instructions. Quality indicators were defined and benchmarked. HbA1c was measured at a central national Diabetes Control and Complications Trial (DCCT) standardized laboratory. Results: The participation increased with 454 type-1 diabetes patients from eight clinics included in 2001 and 1658 patients from 25 clinics in 2005. The adherence rate in 2005 was 85% of all eligible patients from 25 of 26 pediatric clinics. The mean HbA1c of all clinics improved (8.6% in 2001 and 8.1% in 2005)  (p < 0.01). The use of intensive insulin treatment increased from 56% to 78% (p < 0.01) and pumps from 8% to 37% (p < 0.01). The incidence of diabetes ketoacidosis (DKA) remained constant. The incidence of severe hypoglycemia declined insignificantly. The proportion of patients not screened yearly for microalbuminuria and retinopathy,  decreased from 12% to 2% (p < 0.01) and from 42% to 27% (p < 0.01), respectively

Conclusion: Benchmarking combined with organized quality meetings and discussions was effective in  improving  outcome on a national level.

Margeirsdottir HD, Larsen JR, Kummernes SJ, Brunborg C, Dahl-Jørgensen K. The establishment of a new national network leads to quality improvement in childhood diabetes: Implementation of the ISPAD Guidelines. Pediatr Diabetes. 2009 Jun 22. [Epub ahead of print]