Outcome of quality management in pediatric diabetes care.

In 1988 and 1990 screening for HbAlc and albumin excretion rate (AER) in diabetic children was carried out throughout Denmark. Each study included about 1,000 diabetic patients and found HbAlc and insulin requirements increased during maturation in both sexes. No significant differences in HbAlc were seen among adolescents treated with two, three or more daily insulin injections. The prevalence of persistent microalbuminuria was 4.3% which was associated only with age and diastolic blood pressure. An international survey on HbAlc and insulin treatment, involving 2,873 children, showed HbAlc to vary significantly between centers. Severe hypoglycemia was related to younger age (0-8 years) and lower HbAlc. Of the children on twice and three times daily injections, 37% used a premixed form of insulin. Very young children were treated with a higher proportion of long-acting insulin. Among adolescent boys, lower HbAlc was related to the use of more short-acting insulin. The data confirm that current treatment of childhood diabetes is inadequate.