1371-P: Continuing Improvement of Diabetes Control after the Establishment of the Population-Based Childhood Diabetes Register ČENDA

Abstract

Objectives: The Czech National Childhood Diabetes Register (ČENDA) is a web-based nationwide database that collects treatment and outcome data in children and adolescents with diabetes. Here we present data from the first five years of ČENDA (2013-2017). Methods: Data include characteristics of disease onset and annual summaries of key clinical care parameters from every patient treated by participating pediatric diabetes outpatient clinics. Results: The database contains data from 4361 children (aged 0 to 19 years) from 52 centers, which is estimated to be 85% of all Czech pediatric patients. Of these, 94% had type 1 diabetes (T1D), 4.5% had genetically proven monogenic or secondary, and 1.5% had type 2 diabetes. In children with T1D, median HbA1c decreased throughout the observed period from 66.3 to 61.0 mmol/mol (p < 0.0001, 95% confidence interval for change -6 to -5). Consequently, the proportion of children reaching the ADA target therapeutic goal of 58.5 mmol/mol increased from 28% in 2013 to 40% in 2017. This improvement was significant for all categories of age and diabetes duration and was independent of gender. The overall proportion of children treated with continuous subcutaneous insulin infusion (CSII) remained stable over the observed period (25%). The main predictors associated with lower HbA1c were treatment with CSII, male sex and care provided at a large diabetes center (with >100 patients in regular care). Conclusions: A significant continuous decrease in HbA1c was observed in Czech children over the past five years. As this improvement was not accompanied by appreciable changes in the mode of therapy, we assume that the establishment of our nationwide register has itself constituted a stimulus towards improvement in the care process. Disclosure Z. Sumnik: None. M. Pavlíková: None. O. Cinek: None. Funding Ministry of Health of the Czech Republic