Targets and teamwork: Understanding differences in pediatric diabetes centers treatment outcomes

Timothy C Skinner; Karin S Lange; Hilary Hoey; Henrik B Mortensen; Henk-Jan Aanstoot; Luis Castaňo; Soren Skovlund; Peter Gf Swift; Fergus J Cameron; Harry R Dorchy; Mark R Palmert; Eero Kaprio; Jean-Jacques Robert; Thomas Danne; Andreas Neu; Shlomit Shalitin; Francesco Chiarelli; Giovanni Chiari; Tatsuhiko Urakami; Pål R Njølstad; Premyslawa K Jarosz-Chobot; Edna F Roche; Cintia G Castro-Correia; Mirjana Kocova; Jan Åman; Eugen Schönle; Timothy G Barrett; Lynda Fisher; Carine E de Beaufort; Hvidoere Study Group

doi:10.1111/pedi.12606

Targets and teamwork: Understanding differences in pediatric diabetes centers treatment outcomes

Timothy C Skinner, Karin S Lange, Hilary Hoey, Henrik B Mortensen, Henk-Jan Aanstoot, Luis Castaňo, Soren Skovlund, Peter Gf Swift, Fergus J Cameron, Harry R Dorchy, Mark R Palmert, Eero Kaprio, Jean-Jacques Robert, Thomas Danne, Andreas Neu, Shlomit Shalitin, Francesco Chiarelli, Giovanni Chiari, Tatsuhiko Urakami, Pål R NjølstadPremyslawa K Jarosz-Chobot, Edna F Roche, Cintia G Castro-Correia, Mirjana Kocova, Jan Åman, Eugen Schönle, Timothy G Barrett, Lynda Fisher, Carine E de Beaufort, Hvidoere Study Group

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

18 Citationer (Scopus)

Abstract

OBJECTIVE: The reason for center differences in metabolic control of childhood diabetes is still unknown. We sought to determine to what extent the targets, expectations, and goals that diabetes care professionals have for their patients is a determinant of center differences in metabolic outcomes.

RESEARCH DESIGN AND METHODS: Children, under the age of 11 with type 1 diabetes and their parents treated at the study centers participated. Clinical, medical, and demographic data were obtained, along with blood sample for centralized assay. Parents and all members of the diabetes care team completed questionnaires on treatment targets for hemoglobin A1c (HbA1c) and recommended frequency of blood glucose monitoring.

RESULTS: Totally 1113 (53% male) children (mean age 8.0 ± 2.1 years) from 18 centers in 17 countries, along with parents and 113 health-care professionals, participated. There were substantial differences in mean HbA1c between centers ranging from 7.3 ± 0.8% (53 mmol/mol ± 8.7) to 8.9 ± 1.1% (74 mmol/mol ± 12.0). Centers with lower mean HbA1c had (1) parents who reported lower targets for their children, (2) health-care professionals that reported lower targets and more frequent testing, and (3) teams with less disagreement about recommended targets. Multiple regression analysis indicated that teams reporting higher HbA1c targets and more target disagreement had parents reporting higher treatment targets. This seemed to partially account for center differences in Hb1Ac.

CONCLUSIONS: The diabetes care teams' cohesiveness and perspectives on treatment targets, expectations, and recommendations have an influence on parental targets, contributing to the differences in pediatric diabetes center outcomes.

Originalsprog	Engelsk
Tidsskrift	Pediatric Diabetes
ISSN	1399-543X
DOI	https://doi.org/10.1111/pedi.12606
Status	E-pub ahead of print - 20 nov. 2017
Udgivet eksternt	Ja

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10.1111/pedi.12606

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Skinner, T. C., Lange, K. S., Hoey, H., Mortensen, H. B., Aanstoot, H-J., Castaňo, L., Skovlund, S., Swift, P. G., Cameron, F. J., Dorchy, H. R., Palmert, M. R., Kaprio, E., Robert, J-J., Danne, T., Neu, A., Shalitin, S., Chiarelli, F., Chiari, G., Urakami, T., ... Hvidoere Study Group (2017). Targets and teamwork: Understanding differences in pediatric diabetes centers treatment outcomes. Pediatric Diabetes. Advance online publication. https://doi.org/10.1111/pedi.12606

@article{7d242b76bd024f418fb9f114b468a905,

title = "Targets and teamwork: Understanding differences in pediatric diabetes centers treatment outcomes",

abstract = "OBJECTIVE: The reason for center differences in metabolic control of childhood diabetes is still unknown. We sought to determine to what extent the targets, expectations, and goals that diabetes care professionals have for their patients is a determinant of center differences in metabolic outcomes.RESEARCH DESIGN AND METHODS: Children, under the age of 11 with type 1 diabetes and their parents treated at the study centers participated. Clinical, medical, and demographic data were obtained, along with blood sample for centralized assay. Parents and all members of the diabetes care team completed questionnaires on treatment targets for hemoglobin A1c (HbA1c) and recommended frequency of blood glucose monitoring.RESULTS: Totally 1113 (53% male) children (mean age 8.0 ± 2.1 years) from 18 centers in 17 countries, along with parents and 113 health-care professionals, participated. There were substantial differences in mean HbA1c between centers ranging from 7.3 ± 0.8% (53 mmol/mol ± 8.7) to 8.9 ± 1.1% (74 mmol/mol ± 12.0). Centers with lower mean HbA1c had (1) parents who reported lower targets for their children, (2) health-care professionals that reported lower targets and more frequent testing, and (3) teams with less disagreement about recommended targets. Multiple regression analysis indicated that teams reporting higher HbA1c targets and more target disagreement had parents reporting higher treatment targets. This seemed to partially account for center differences in Hb1Ac.CONCLUSIONS: The diabetes care teams' cohesiveness and perspectives on treatment targets, expectations, and recommendations have an influence on parental targets, contributing to the differences in pediatric diabetes center outcomes.",

keywords = "Journal Article",

author = "Skinner, {Timothy C} and Lange, {Karin S} and Hilary Hoey and Mortensen, {Henrik B} and Henk-Jan Aanstoot and Luis Casta{\v n}o and Soren Skovlund and Swift, {Peter Gf} and Cameron, {Fergus J} and Dorchy, {Harry R} and Palmert, {Mark R} and Eero Kaprio and Jean-Jacques Robert and Thomas Danne and Andreas Neu and Shlomit Shalitin and Francesco Chiarelli and Giovanni Chiari and Tatsuhiko Urakami and Nj{\o}lstad, {P{\aa}l R} and Jarosz-Chobot, {Premyslawa K} and Roche, {Edna F} and Castro-Correia, {Cintia G} and Mirjana Kocova and Jan {\AA}man and Eugen Sch{\"o}nle and Barrett, {Timothy G} and Lynda Fisher and {de Beaufort}, {Carine E} and {Hvidoere Study Group}",

note = "{\textcopyright} 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.",

year = "2017",

month = nov,

day = "20",

doi = "10.1111/pedi.12606",

language = "English",

journal = "Pediatric Diabetes",

issn = "1399-543X",

publisher = "Munksgaard ",

}

Skinner, TC, Lange, KS, Hoey, H, Mortensen, HB, Aanstoot, H-J, Castaňo, L, Skovlund, S, Swift, PG, Cameron, FJ, Dorchy, HR, Palmert, MR, Kaprio, E, Robert, J-J, Danne, T, Neu, A, Shalitin, S, Chiarelli, F, Chiari, G, Urakami, T, Njølstad, PR, Jarosz-Chobot, PK, Roche, EF, Castro-Correia, CG, Kocova, M, Åman, J, Schönle, E, Barrett, TG, Fisher, L, de Beaufort, CE & Hvidoere Study Group 2017, 'Targets and teamwork: Understanding differences in pediatric diabetes centers treatment outcomes', Pediatric Diabetes. https://doi.org/10.1111/pedi.12606

TY - JOUR

T1 - Targets and teamwork

T2 - Understanding differences in pediatric diabetes centers treatment outcomes

AU - Skinner, Timothy C

AU - Lange, Karin S

AU - Hoey, Hilary

AU - Mortensen, Henrik B

AU - Aanstoot, Henk-Jan

AU - Castaňo, Luis

AU - Skovlund, Soren

AU - Swift, Peter Gf

AU - Cameron, Fergus J

AU - Dorchy, Harry R

AU - Palmert, Mark R

AU - Kaprio, Eero

AU - Robert, Jean-Jacques

AU - Danne, Thomas

AU - Neu, Andreas

AU - Shalitin, Shlomit

AU - Chiarelli, Francesco

AU - Chiari, Giovanni

AU - Urakami, Tatsuhiko

AU - Njølstad, Pål R

AU - Jarosz-Chobot, Premyslawa K

AU - Roche, Edna F

AU - Castro-Correia, Cintia G

AU - Kocova, Mirjana

AU - Åman, Jan

AU - Schönle, Eugen

AU - Barrett, Timothy G

AU - Fisher, Lynda

AU - de Beaufort, Carine E

AU - Hvidoere Study Group

PY - 2017/11/20

Y1 - 2017/11/20

N2 - OBJECTIVE: The reason for center differences in metabolic control of childhood diabetes is still unknown. We sought to determine to what extent the targets, expectations, and goals that diabetes care professionals have for their patients is a determinant of center differences in metabolic outcomes.RESEARCH DESIGN AND METHODS: Children, under the age of 11 with type 1 diabetes and their parents treated at the study centers participated. Clinical, medical, and demographic data were obtained, along with blood sample for centralized assay. Parents and all members of the diabetes care team completed questionnaires on treatment targets for hemoglobin A1c (HbA1c) and recommended frequency of blood glucose monitoring.RESULTS: Totally 1113 (53% male) children (mean age 8.0 ± 2.1 years) from 18 centers in 17 countries, along with parents and 113 health-care professionals, participated. There were substantial differences in mean HbA1c between centers ranging from 7.3 ± 0.8% (53 mmol/mol ± 8.7) to 8.9 ± 1.1% (74 mmol/mol ± 12.0). Centers with lower mean HbA1c had (1) parents who reported lower targets for their children, (2) health-care professionals that reported lower targets and more frequent testing, and (3) teams with less disagreement about recommended targets. Multiple regression analysis indicated that teams reporting higher HbA1c targets and more target disagreement had parents reporting higher treatment targets. This seemed to partially account for center differences in Hb1Ac.CONCLUSIONS: The diabetes care teams' cohesiveness and perspectives on treatment targets, expectations, and recommendations have an influence on parental targets, contributing to the differences in pediatric diabetes center outcomes.

AB - OBJECTIVE: The reason for center differences in metabolic control of childhood diabetes is still unknown. We sought to determine to what extent the targets, expectations, and goals that diabetes care professionals have for their patients is a determinant of center differences in metabolic outcomes.RESEARCH DESIGN AND METHODS: Children, under the age of 11 with type 1 diabetes and their parents treated at the study centers participated. Clinical, medical, and demographic data were obtained, along with blood sample for centralized assay. Parents and all members of the diabetes care team completed questionnaires on treatment targets for hemoglobin A1c (HbA1c) and recommended frequency of blood glucose monitoring.RESULTS: Totally 1113 (53% male) children (mean age 8.0 ± 2.1 years) from 18 centers in 17 countries, along with parents and 113 health-care professionals, participated. There were substantial differences in mean HbA1c between centers ranging from 7.3 ± 0.8% (53 mmol/mol ± 8.7) to 8.9 ± 1.1% (74 mmol/mol ± 12.0). Centers with lower mean HbA1c had (1) parents who reported lower targets for their children, (2) health-care professionals that reported lower targets and more frequent testing, and (3) teams with less disagreement about recommended targets. Multiple regression analysis indicated that teams reporting higher HbA1c targets and more target disagreement had parents reporting higher treatment targets. This seemed to partially account for center differences in Hb1Ac.CONCLUSIONS: The diabetes care teams' cohesiveness and perspectives on treatment targets, expectations, and recommendations have an influence on parental targets, contributing to the differences in pediatric diabetes center outcomes.

KW - Journal Article

U2 - 10.1111/pedi.12606

DO - 10.1111/pedi.12606

M3 - Journal article

C2 - 29159931

SN - 1399-543X

JO - Pediatric Diabetes

JF - Pediatric Diabetes

ER -

Targets and teamwork: Understanding differences in pediatric diabetes centers treatment outcomes

Abstract

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