Improving the outcome for children and adolescents with type 1 diabetes: results of a changing service in Copenhagen

Abstract

In 1995, an international study of HbA1c levels in 22 centres showed that our centre in Glostrup, Copenhagen, recorded a mean HbA1c significantly above the average. As a consequence, we instituted a series of changes in the structure and process of our service. During the period from 1995 to 1998 we have closely monitored and evaluated the human and financial resources to optimise outpatient care. We reorganised the work of the medical and paramedical staff to concentrate more on outpatient than on inpatient management, established a 24 hour dedicated telephone hotline and defined clear standards of care and criteria for evaluation. In 1993, new rules for the referral system in the Copenhagen area were agreed, resulting in more children being seen at our centre. Consequently, a single, large, centralised children's clinic for Copenhagen was founded at Glostrup. Despite the increased number of children being seen, the changes made have resulted in a reduction in hospital admissions and a fall in mean HbA1c of approximately 1% across all age groups. This process was facilitated by use of a quality-focused computer program allowing easy data access and surveillance. Copyright © 2000 John Wiley & Sons, Ltd.