Glycemic control in children with type 1 diabetes in wales: influence of the pediatric diabetes specialist nurse.

Abstract

To determine whether glycemic control is improving in diabetic children in Wales and to identify factors associated with improvement. Data were collected in 2001 and 2006. Over time A1C was reduced from 9.08 +/- 1.66 to 8.88 +/- 1.63% (P = 0.012). There were differences among centers (P < 0.001) and differential changes over time (interaction P < 0.001). Since 2001 five centers had appointed a pediatric diabetes specialist nurse (PDSN). A1C improved in these centers from 9.59 +/- 1.88 to 8.72 +/- 1.61% (P < 0.001). Glycemic control was worse in children aged >10 years compared with younger patients (P < 0.001). Improvement occurred in those aged >10 years. Age (P = 0.003) and insulin dose (P < 0.001) were positively and independently associated with A1C. Thus, any influence of PDSNs was not achieved through increased insulin prescription. Improvement in glycemic control has occurred. Worse control is associated with greater prescribed insulin dose in older children. Appointment of PDSNs was associated with improved glycemic control among adolescents.