PMID:
     20435792
Authors:
     O'Hagan M, Harvey JN.
Title:
     Glycemic control in children with type 1 diabetes in wales: influence of the 
     pediatric diabetes specialist nurse.
Journal:
     Diabetes Care. 2010 Aug;33(8):1724-6. doi: 10.2337/dc09-2304. Epub 2010 Apr 30.
Abstract:
     OBJECTIVE: To determine whether glycemic control is improving in diabetic 
     children in Wales and to identify factors associated with improvement. RESEARCH 
     DESIGN AND METHODS: Data were collected in 2001 and 2006. RESULTS: Over time A1C 
     was reduced from 9.08 +/- 1.66 to 8.88 +/- 1.63% (P = 0.012). There were 
     differences among centers (P < 0.001) and differential changes over time 
     (interaction P < 0.001). Since 2001 five centers had appointed a pediatric 
     diabetes specialist nurse (PDSN). A1C improved in these centers from 9.59 +/- 
     1.88 to 8.72 +/- 1.61% (P < 0.001). Glycemic control was worse in children aged 
     >10 years compared with younger patients (P < 0.001). Improvement occurred in 
     those aged >10 years. Age (P = 0.003) and insulin dose (P < 0.001) were 
     positively and independently associated with A1C. Thus, any influence of PDSNs 
     was not achieved through increased insulin prescription. CONCLUSIONS: Improvement 
     in glycemic control has occurred. Worse control is associated with greater 
     prescribed insulin dose in older children. Appointment of PDSNs was associated 
     with improved glycemic control among adolescents.

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