ABSTRACT

This PhD dissertation summarises the results of three papers. The study was conducted in cooperation between the Department of Paediatrics, Glostrup University Hospital, and Research Centre for Prevention and Health, Copenhagen County.

The aims of the present study were to describe the current management of type 1 diabetes mellitus in Denmark in children and adolescents using quality indicators, and to compare outcome of care at the centres managing these children and adolescents. A further aim was to study associations between the structure, process, and outcome of care.

Data originated from the nationwide clinical database the Danish Registry for Childhood Diabetes supplemented with data from two questionnaires. One questionnaire was sent to all children and adolescents under 18 years in the Danish Registry for Childhood Diabetes in year 2000 (N = 1335) and the other was sent to the 19 centres managing these children. The children were also asked to return a blood sample for central HbA1c-analysis.

Quality indicators with standards were developed for the structure, process, and outcome of type 1 diabetes management in children and adolescents, but most of these standards were not accomplished. Approximately one third of the children reached the recommended level of HbA1c with the best result for the youngest children for whom the treatment target was less tight.

Significant differences in mean HbA1c-values were found between centres before and after adjustment for differences in age, sex, diabetes duration, and ethnic background between the populations at the centres.

The overall adjusted mean HbA1c-value was 8.9% in year 2000 and 8.8% in year 2001. A statistically significant difference was found between centres for both years, and the mean HbA1c-values at the different centres were persistent without significant interchanges between 2000 and 2001.

Most of the process indicators but none of the structure indicators were associated with HbA1c. Increased frequency of blood glucose monitoring was significantly associated with lower HbA1c.

A possible indirect association between structure and outcome was found as access to telephone hot-line service (structure) was associated with increased frequency of blood glucose monitoring (process) which in turn was associated with lower HbA1c (outcome).

The outcome of the management of type 1 diabetes mellitus in Danish children and adolescents was unsatisfactory. The clinical database the Danish Registry for Childhood Diabetes is useful for nationwide monitoring of the outcome of childhood-diabetes care. Future analyses including data from more years in the present analysis models will make it possible to identify factors associated with high quality of care.