Exploring Variation in Glycemic Control Across and Within Eight High-Income Countries: A Cross-sectional Analysis of 64,666 Children and Adolescents With Type 1 Diabetes
Exploring Variation in Glycemic Control Across and Within Eight High-Income Countries: A Cross-sectional Analysis of 64,666 Children and Adolescents With Type 1 Diabetes
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DOI：
10.2337/dc17-2271
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发表时间：
2018-06-01
期刊：
影响因子：
16.2
通讯作者：
Hanas, Ragnar
中科院分区：
文献类型：
--
作者：
Charalampopoulos, Dimitrios;Hermann, Julia M.;Hanas, Ragnar
关于儿童1型糖尿病（T1 D）的国际研究集中在全国平均HbA（1c）水平，从而掩盖了国家内部的潜在差异。研究设计和方法数据收集自2013年至2014年，来自德国、奥地利、英格兰、威尔士、美国、英国和美国的528个中心的64，666名18岁以下T1 D儿童。瑞典、丹麦和挪威。我们使用了调整了年龄、性别、糖尿病病程和少数民族状况的固定和随机效应模型来描述中心平均值之间的差异，并计算可归因于中心间差异的HbA（1c）水平总变异的比例（组内相关性[ICC]）。我们还探讨了中心内变异与儿童血糖控制之间的关系，结果表明，瑞典的平均HbA（1c）最低（59 mmol/mol [7.6%]），挪威和丹麦的中心间变异最低（ICC
OBJECTIVEInternational studies on childhood type 1 diabetes (T1D) have focused on whole-country mean HbA(1c) levels, thereby concealing potential variations within countries. We aimed to explore the variations in HbA(1c) across and within eight high-income countries to best inform international benchmarking and policy recommendations.RESEARCH DESIGN AND METHODSData were collected between 2013 and 2014 from 64,666 children with T1D who were < 18 years of age across 528 centers in Germany, Austria, England, Wales, U.S., Sweden, Denmark, and Norway. We used fixed-and random-effects models adjusted for age, sex, diabetes duration, and minority status to describe differences between center means and to calculate the proportion of total variation in HbA(1c) levels that is attributable to between-center differences (intraclass correlation [ICC]). We also explored the association between within-center variation and children's glycemic control.RESULTSSweden had the lowest mean HbA(1c) (59mmol/mol [7.6%]) and together with Norway and Denmark showed the lowest between-center variations (ICC