Equal access to health care may diminish the differences in outcome between native and immigrant patients with type 1 diabetes.

BACKGROUND/OBJECTIVE: Previous studies have found that ethnicity influences glycemic control. We hypothesized that differences between Nordic and non-Nordic patients are less pronounced for children with type 1 diabetes in high incidence countries in Northern Europe. RESEARCH DESIGN AND METHODS: We investigated patients aged 0-15 yr in national pediatric registers in Denmark (D), Iceland (I), Norway (N), and Sweden (S) (2006-2009). Ethnic origin was defined by maternal country of birth as being Nordic or non-Nordic (other countries). RESULTS: The cohort (n = 11,908, 53.0% boys, onset age 7.7 (3.9) yr, diabetes duration 6.1 (3.6) yr, [mean, (SD)]) comprised 921 (7.7%) non-Nordic patients. The frequencies of non-Nordic patients according to country of residence were: 5.7% (D), 2.7% (I), 5.5% (N), and 9.4% (S). Sex distribution and BMI z-score did not differ between Nordic and non-Nordic patients, but non-Nordic patients were 0.5 yr younger at onset than Nordic patients (p < 0.0006). Non-Nordic patients had a lower number of daily insulin bolus injections and higher daily insulin doses compared to their Nordic peers. Patients of non-Nordic origin had slightly higher HbA1c levels (0.6-2.9 mmol/mol, p < 0.001) and, with the exception of Norway, were less frequently treated with CSII (p = 0.002) after adjusting for confounders. CONCLUSIONS: The reported differences in glycemic regulation between Nordic and non-Nordic type 1 diabetes children and adolescents in four Nordic countries are diminutive, but persist after accounting for treatment intensity.

Childhood diabetes in the Nordic countries: a comparison of quality registries.

In 2008 a Nordic collaboration was established between the quality registries in Denmark, Iceland, Norway, and Sweden to improve quality of care for children with diabetes. This study aimed to describe those registries and confirm that the registry variables are comparable. Selected variables were used to demonstrate outcome measurements. The organization of the registries and methodology are described. Cross-sectional data for patients between birth and 14.9 years with type 1 diabetes mellitus in 2009 (n = 6523) from 89 centers were analyzed. Variables were age, gender, and diabetic ketoacidosis at onset, together with age, gender, HbA1c, insulin regimen, and severe hypoglycemia at follow-up in 2009. All 4 registries use a standardized registration at the onset of diabetes and at follow-up, conducted at the local pediatric diabetes centers. Methods for measuring HbA1c varied as did methods of registration for factors such as hypoglycemia. No differences were found between the outcomes of the clinical variables at onset. Significant variations were found at follow-up for mean HbA1c, the proportion of children with HbA1c < 57 mmol/mol (NGSP/DCCT 7.4%), (range 15-31%), the proportion with insulin pumps (range 34-55%), and the numbers with severe hypoglycemia (range 5.6-8.3/100 patient years). In this large unselected population from 4 Nordic countries, a high proportion did not reach their treatment target, indicating a need to improve the quality of pediatric diabetes care. International collaboration is needed to develop and harmonize quality indicators and offers possibilities to study large geographic populations, identify problems, and share knowledge.

Incidence of type 1 diabetes in Norway among children aged 0-14 years between 1989 and 2012: has the incidence stopped rising? Results from the Norwegian Childhood Diabetes Registry.

AIMS/HYPOTHESIS: Our study aimed to describe the incidence of type 1 diabetes in children below 15 years of age in Norway during the period 1989-2012 and to assess the regional variation during 2004-2012. We further set out to estimate the completeness of ascertainment in the Norwegian Childhood Diabetes Registry (NCDR). METHODS: Incident cases of type 1 diabetes were registered in the NCDR and incidence rates were modelled using Poisson regression. Ascertainment for 2005-2008 was estimated using capture-recapture methodology by using data from the Norwegian Prescription Database (NorPD), a nationwide register established in 2004, which included insulin prescribed and dispensed at pharmacies to individual patients. Population data were obtained from Statistics Norway. RESULTS: Observed incidence rates for 1989-2012 suggested three distinct time segments: in 1989-1996, the average incidence rate was 22.6 per 100,000 person-years (95% CI 21.4, 23.7); in 1996-2004, the average incidence rate was 28.4 per 100,000 person-years (95% CI 27.3, 29.6); and from 2004 to 2012, the average incidence rate per 100,000 person-years was 32.7 (95% CI 31.5, 34.0). After adjustment for age and sex, the estimated change per year was 1.8% for 1989-1996 (95% CI -0.07, 3.6; p = 0.059), 3.4% for 1996-2004 (95% CI 2.2, 4.7; p < 0.0001) and 0.3% for 2004-2012 (95% CI -0.9, 1.6; p = 0.64). The highest incidence was in the age group 10-14 years for both sexes. A significant regional variation in incidence was observed (p < 0.001). Completeness of ascertainment in the NCDR was estimated to be 91%. CONCLUSIONS/INTERPRETATION: The previously observed increase in incidence of type 1 diabetes has levelled off and remained essentially constant at 32.7 per 100,000 person-years during 2004-2012. There is a significant variation in type 1 diabetes incidence within Norway.