Glycemic Control in Children With Type 1 Diabetes in Wales: Influence of the pediatric diabetes specialist nurse

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.