Comparison of metabolic control in a cross-sectional study of 2,873 children and adolescents with IDDM from 18 countries

OBJECTIVE - To obtain an estimate of the current level of metabolic control in children and adolescents with IDDM, the Hvidore Study Group on Childhood Diabetes decided to establish a formal collaboration among countries to gather and exchange data for comparative purposes. RESEARCH DESIGN AND METHODS - This cross-sectional non-population-based survey involved 22 pediatric departments from 18 countries in Europe, Japan, and North America. Blood samples and information were collected from March through August 1995 on 2,873 children who were born in 1977 or later and seen in the outpatient clinics. HbA(1c) levels were determined once and analyzed centrally (normal range, 4.3-6.1%; mean, 5.4%). Year of birth, sex, duration of diabetes, height, body weight, insulin regimen, and number of episodes of severe hypoglycemia during the past 3 months were recorded. RESULTS - Average HbA(1c) was 8.6 +/- 1.7%, but varied significantly (P < 0.0001) between centers. Hypoglycemia resulting in unconsciousness and/or seizures was related to younger age (0-8 years) and lower HbA(1c) level. The incidence, based on the 3-month period, was 22 per 100 patient-years. Sixty percent of the children (n = 1,707) had two injections daily, while 37% (n = 1,071) were on three or more. HbA(1c) increased during maturation for both sexes. No difference in glycemic control was found among adolescents treated with two, three, and four or more daily injections. Adolescents on four or more injections received significantly (P < 0.001) more insulin. Girls on four or more injections had significantly (P < 0.01) higher BMI than girls on mice-daily insulin. CONCLUSIONS - In the participating centers with a multidisciplinary team, only one third of the patients had an HbA(1c) level of <8%.