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 participation in a quality improvement project. RESEARCH DESIGN AND METHODS This longitudinal observational study was 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). Continuous glucose monitoring (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 a higher mean HbA1c than boys. Mean HbA1c levels were lower in clinics that participated in a quality improvement project for the following 4 years after the project. CONCLUSIONS Diabetes technology, carbohydrate counting, and systematic quality improvement in pediatric departments led to improved glycemic control.

中文翻译：

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改善儿科糖尿病护理血糖控制的十年：来自挪威儿童糖尿病登记处的数据

目的 评估从 2013 年到 2022 年，挪威国家层面的 HbA1c、急性并发症发生率和糖尿病技术的使用发生了怎样的变化，以及血糖控制与糖尿病技术的使用、碳水化合物计数或参与质量评估之间的关系。改进项目。研究设计和方法 这项纵向观察性研究基于 2013 年至 2022 年挪威儿童糖尿病登记处 6,775 名儿童的 27,214 项年度登记。年龄 > 18 岁的个体、患有 1 型以外糖尿病的个体以及没有 HbA1c 测量值的个体被排除在外。结果指标是 HbA1c。调整后的线性混合效应模型中的预测变量是 1) 糖尿病技术的使用，2) 膳食推注中碳水化合物计数的使用，以及 3) 患者的糖尿病团队是否参与质量改进项目。结果 平均 HbA1c 从 8.2% (2013 年) 下降至 7.2% (2021 年)，HbA1c <7.0% 的青少年比例从 13% (2013 年) 增加至 43% (2022 年)。胰岛素泵的使用率从 65% (2013 年) 增加到 91% (2022 年)。连续血糖监测 (CGM) 的使用率从 34%（首次记录于 2016 年）增加到 97%（2022 年）。胰岛素泵、CGM 和碳水化合物计数与较低的 HbA1c 和较高的血糖目标实现相关。女孩的平均 HbA1c 高于男孩。参与质量改进项目的诊所在项目结束后的 4 年内平均 HbA1c 水平较低。结论儿科的糖尿病技术、碳水化合物计数和系统质量改进改善了血糖控制。