Lessons from the Hvidoere International Study Group on childhood diabetes: be dogmatic about outcome and flexible in approach.
2013
Type 1 diabetes is one of the most commonchronic diseases of childhood.
Between 1989 and 2003, the incidence of type 1 diabetes in youth increased
at approximately 3.9% per year with a projected doubling of cases in
children aged <5 yr between 2005 and 2015 (1). This has substantial
impact on those affected, their families, on pediatric diabetes care, and
on national health care budgets. Much has changed over the last decade
in terms of management strategies in type 1 diabetes, however, as Edwin
Gale editorialized in 2005 that the challenges of diabetes remain much the
same (2). In short, there are more cases resulting in increasing disease years
characterized by greater medical and psychosocial complexity. The Hvidoere International Study Group on Childhood Diabetes
evolved in 1994 during a meeting that was held in the immediate post
Diabetes Control and Complication Trial (DCCT, 3) era to discuss
strategies that could improve the quality of pediatric diabetes care
and thereby improve subsequent adult outcomes. The objectives and
mission statement of the Hvidoere group can be found on its website
http://www.hvidoeregroup.org/. In short, this unique collaboration of 26
pediatric diabetes centers from 23 countries (Europe, North America,
Japan, and Australia) has undertaken a series of research projects
investigating critical determinants for long-term outcome of type 1
diabetes care discriminating in terms of outcomes and which aspects of
care are universally effective. In all the Hvidoere studies, HbA1c was
analyzed centrally at the Steno Diabetes Center, Denmark. In the period
from 1997 to December 2002 HbA1c was analyzed using an automated
high pressure liquid chromatographic method (Bio-Rad Variant, Bio-Rad
Laboratories, Hercules, CA, USA) using the same calibrator lots as
the DCCT laboratory. From 2003 till now, HbA1c was analyzed by
the DCCT aligned TOSOH Automated Glycohemoglobin Analyzer
HLC-723G7, Tosoh Corporation, Tokyo, Japan. Five major studies have been undertaken, both crosssectional
and longitudinal, serving this goal. The
findings detailed below show that these studies have led
to an internationally recognized remission parameter
(4) and have validated well-being and quality-of-life
(QOL) questionnaires (with relevant translation, (5).
The key thematic and practical findings of this body
of work (published in 28 peer reviewed medical and
scientific journals) are summarized in this review.
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