Exploring the feasibility of combining chronic disease patient registry data to monitor the status of diabetes care.

INTRODUCTION: To provide direction and to support improvements in diabetes care, states must be able to measure the effectiveness of interventions and gain feedback on progress. We wanted to know if data from multiple health clinics that are implementing quality improvement strategies could be combined to provide useful measurements of diabetes care processes and control of intermediate outcomes. METHODS: We combined and analyzed electronic patient health data from clinic sites across Washington State that used the Chronic Disease Electronic Management System (CDEMS) registry. The data were used to determine whether national and state objectives for diabetes care were met. We calculated the percentage of patients that met standards of care in 2004. RESULTS: The pooled dataset included 17,349 adult patients with diabetes from 90 clinics. More than half of patients were above recommended target levels for hemoglobin A1c testing, foot examination, hemoglobin A1c control, and low-density lipoprotein cholesterol control. Fewer patients met recommendations for nephropathy assessment, eye examinations, and blood pressure control. In terms of meeting these standards, rates of diabetes care varied across clinics. CDEMS rates of care were compared with those reported by other data sources, but no consistent pattern of similarities or differences emerged. CONCLUSION: With committed staff time, provider support, and resources, data from clinical information systems like CDEMS can be combined to address a deficiency in state-level diabetes surveillance and evaluation systems--specifically, the inability to capture clinical biometric values to measure intermediate health outcomes. These data can complement other surveillance and evaluation data sources to help provide a better picture of diabetes care in a state.

Glycemic, auxologic, and seasonal aspects of continuous subcutaneous insulin infusion therapy in children and young adults with type 1 diabetes.

Use of continuous subcutaneous insulin infusion (CSII) therapy has increased among patients with type 1 diabetes. This study was performed: (1) to evaluate the effect of CSII on diabetes control in children and young adults, (2) to detect effects of CSII on weight, body mass index (BMI), and insulin requirements, (3) to investigate seasonal variation in diabetes control during CSII therapy, and (4) to investigate the effect of season of initiation of CSII on glycemic control. Thirty-nine patients, ranging in age from 10.1 to 20.5 years, with type 1 diabetes were studied. Quarterly data over 12 months preceding and following CSII initiation were obtained retrospectively. Variables were compared over similar time periods. SAS was used for descriptive and paired t test analysis. (1) Mean blood glucose level was significantly lower at 3 months but not different from baseline at 6, 9, and 12 months post-CSII. (2) Glycosylated hemoglobin (HbA1c) was significantly lower at 3 and 6 months but not at 9 and 12 months post-CSII. (3) There was no significant difference in the frequency of hypoglycemia or hyperglycemia at any of the time periods studied. (4) There was an initial but unsustained decrease in daily weight-adjusted insulin requirements after CSII. (5) There was a rapid, sustained increase in weight and BMI following CSII in females. (6) Frequency of ketoacidosis decreased in two patients. (7) There was no seasonal variation in weight change, HbA1c, or frequency of measured hypoglycemic episodes with CSII. (8) There was some effect of the season of initiation of CSII therapy on glycemic control. Thus, (1) CSII glycemic benefits may not be sustained, (2) weight gain is a significant effect of CSII in adolescent females, and (3) CSII may be a means of decreasing ketoacidosis episodes, and eliminating seasonal variability in diabetes control.

Clinical, autoimmune, and HLA characteristics of children diagnosed with type 1 diabetes before 5 years of age.

BACKGROUND: Little is known about auxologic, autoimmune, and HLA characteristics specific to children with early-onset diabetes (EOD). HLA subtypes have been shown to play an important part in the determination of islet-cell autoimmunity and in the pace and intensity of the beta-cell destructive process. OBJECTIVES: Our goals were to: 1) outline auxologic, autoimmune, and HLA class II characteristics of children diagnosed with type 1 diabetes before 5 years of age (EOD); 2) evaluate differences between EOD and later-onset or non-age-stratified type 1 diabetes; and 3) investigate the relation between type 1 diabetes-related HLA subtypes and markers of diabetic autoimmunity in EOD. METHODS: Forty children with EOD were studied. Auxologic and antibody radioimmunoassay data were obtained by retrospective analysis of records. HLA diabetes-related class II alleles were typed by polymerase chain reaction using sequence-specific primers. RESULTS: At diagnosis, the average age of the EOD study patients was 2.6 years, body mass index was 16.9 kg/m2, and weight was 106% of average weight for height. When compared with a matched subgroup of children with later-onset type 1 diabetes, preschoolers did not significantly differ in terms of birth weight or body mass index. The frequency of positive islet cell antibodies 512 and glutamic acid decarboxylase 65 antibodies was significantly less in EOD (28.6% and 31.6%, respectively). There were significant differences in the frequencies of some diabetes-related HLA alleles and haplotypes between the early-onset group and a large non-age-stratified type 1 diabetes group. None of the patients with EOD had either of the protective DRB1*1501 or DQB1*0602 alleles. There was a negative correlation between glutamic acid decarboxylase and the predisposing haplotype DR3/DQ2. CONCLUSIONS: Children diagnosed with type 1 diabetes before 5 years of age may have different diabetes-related autoimmune and genetic characteristics from those diagnosed at a later age.