Ten years of improving glycemic control in pediatric diabetes care: Data from the Norwegian Childhood Diabetes Registry

Objective: To evaluate, from 2013 to 2022, how HbA1c, the incidence of acute complications, and use of diabetes technology changed at the national level in Norway and how glycemic control was associated with use of diabetes technology, carbohydrate counting, or the participation in a quality improvement project.

Research Design and Methods: This is a longitudinal observational study, based on 27,214 annual registrations of 6,775 children from the Norwegian Childhood Diabetes Registry from 2013 to 2022. Individuals aged >18 years, those with diabetes other than type 1, and those without HbA1c measurements were excluded. The outcome measure was HbA1c. The predictor variables in the adjusted linear mixed-effects model were (1) the use of diabetes technology, (2) the use of carbohydrate counting for meal bolusing, and (3) whether the patient’s diabetes team participated in a quality improvement project.

Results: Mean HbA1c decreased from 8.2% (2013) to 7.2% (2021), and the proportion of youth reaching an HbA1c <7.0% increased from 13% (2013) to 43% (2022). Insulin pump use increased from 65% (2013) to 91% (2022). CGM use increased from 34% (first recorded in 2016) to 97% (2022). Insulin pump, CGM, and carbohydrate counting were associated with lower HbA1c and higher achievement of glycemic targets. Girls had higher mean HbA1c than boys. Mean HbA1c levels were lower in clinics that participated in a quality improvement project for the following four years after the project.

Conclusions: Diabetes technology, carbohydrate counting, and systematic quality improvement in pediatric departments led to improved glycemic control.