University Hospital Leuven (UZ Leuven) Gasthuisberg Campus, Department of Pediatrics
Prof. Dr. Kristina Casteels
Pediatric diabetes care in Belgium is well organized: there are 13 hospital-based multidisciplinary pediatric diabetes centers where children with diabetes are treated and cared for.
The diabetes center of UZLeuven (University Hospital Leuven) currently has 278 patients in its care: 252 with type 1 diabetes, 11 patients with MODY, 3 type 2 diabetes patients, 2 neonatal diabetes patients and 2 children with secondary diabetes. It boasts a multidisciplinary team consisting of 3 doctors, 3 nurses, 3 dieticians, one psychologist, a social assistant and a secretary. Team work is a key element and we are convinced that a good communication between the different team members is essential for optimal patient care. The team meets twice a week and discusses all the patients that were hospitalized or seen at the outpatient clinic.
Newly diagnosed patients are hospitalized for at least 1 week and are educated in detail, also on diet and insulin titration. Afterwards patients are seen every three months. All members of the team are present on consultation: this lowers the threshold to seek advice with the dietician or psychologist. We are proud of our education system because we see that the effort to educate patients so thoroughly (which is time consuming) results in superior metabolic control.
Since 2008, a Quality Improvement Initiative has been implemented among pediatric diabetes centers in Belgium (Initiative for Quality improvement and Epidemiology among Children and Adolescents with Diabetes: IQECAD). It involves annual audits and feedback of performance indicators to the centers, aimed at improving care. Median HbA1c of our center in 2013 was 7.28 % (7.35% in patients with diabetes for more than 1 year).
Since 2013 our center is also member of SWEET (collaborative center). Being a member of SWEET is a true enrichment as contact with other centers broadens our perspective by giving insight into the organization of diabetes care in different countries. The more centers are involved in this collaboration, the richer the exchange of data will become. It is hoped that improvement in pediatric diabetes care will thus be achieved.
The Pediatric Departement, Semmelweis University, Budapest, Hungary
Prof. Dr. László Madácsy
The Pediatric Departement of the SemmelweisUniversity in Budapest, Hungary is a University affiliated, non-profit institute that cares for more than 600 patients. The Centre has 14 in-patient beds for children suffering of diabetes mellitus and of endocrinological diseases. It also has an out-patient clinic that is dedicated to the provision of education for patients. Last year 2500 patients were seen in this clinic. The Centre’s staff is multidisciplinary and consists of four Pediatric diabetologists, one pediatric endocrinologist, one pediatric resident, one pediatric psychologist, two diabetes nurse/educators, one dietician, and one social worker.
The 1st Department of Pediatrics of SemmelweisUniversity was founded in 1839, with the foundation of the Poor Children’s Hospital by Agost Schöpf-Merei. Since the middle of the 20th century a regional and nationwide Centre for children and adolescents with diabetes mellitus has been developed in the 1st Department of Paediatrics with the leadership of Professor Lajos Barta, who has written and published the first medical textbook on childhood diabetes in Hungarian in 1961. Following the political changes in Central and Eastern Europe, the very first ISPAD (ISGD) Postgraduate Course behind the formal „iron courtain” has been organised by the members of the Center with the leadership of Professor Bruno Weber (President of ISPAD) at Dobogókő, Hungary in January 1991. During the last 25 years an intensive cooperation in scientific research developed between the members of the Center and several famous foreign Pediatric Clinics as the Children’s Hospital of Helsinki, the Freie Universitat of Berlin, the Kinder- und Jungenkrankenhaus of Hannover and the Karolinska Institut of Stockholm. The average rate of scientific publications was 7 per year in the last ten years.
The representative of the Center has had the option to participate - as an active member of the Group - in the realization of the Europroject SWEET (2008-2010). Then, in the year of 2011, the Center - by fulfilling the criteria and requirements for a SWEETCollaborativeCenter - obtained the certification.
The clinic benefits from being in the SWEET network by having access to standardized patient education programmes and pediatric training programmes for young pediatricians interested in diabetology and endocrinology. The opportunity to participate in international research projects is a great benefit as well. We strongly hope, that in the near future the developing SWEET network will be able to improve the care of children and adolescents with diabetes and to increase the efficacy of the prevention of long-term diabetic complications across Europe and beyond.
Regional Centre for Diabetes in Children and Adolescents, Marche Region, Ancona, Italy
Prof. Dr. Valentino Cherubini, Lucia Ferrito
The Regional Centre for Diabetes in Children and Adolescent of “Salesi Hospital”, located in Ancona, East Coast, Central Italy, is a Complex Unit within the Department of Women’s and Children’s Health. The Hospital includes many paediatric structures such as surgery, emergency, neuropsychiatry, oncology, cardiology, and nephrology. The Centre’s staff consists of two full time doctors, one medical student, two nurses, one dietician and one psychologist. The Centre continuously follows about 300 patients less than 18, and more than 150 for occasional consultation. We are proud to observe very low rates of acute complications and a good average metabolic control (mean HbA1c: 7.53%), with the target HbA1c reached by more than 45% patients. Currently more than one third of the patients are using insulin pumps, and 10% a glucose sensor. Our attention is also addressed to inpatients with critical conditions, diabetes-related education, organization of at least three camps per year, and arrangements of meetings in schools to facilitate the child readmission after the diagnosis. Clinical research is another consistent part of our interest. A regional server stores the electronic records of young and adult diabetic patients and allows data sharing among centres, also facilitating the transition of subjects to the adult centre. We manage the regional registry for diabetes in young patients and the national coordination of the "Registry for Type 1 Diabetes in Italy", established in 1997. The SWEET network gave us the opportunity to better analyse the current status of the diabetes care provided by our Centre, and comparing to other EU centres. We get significant information on weaknesses and strengths of treatment, on potential predictors of its success and possible measures of life quality. Since our inclusion in the network we tried to optimize diabetes care and outcome by further enhancing the general diabetes-related education, the skills training, the psychosocial issues and the behavioural and self-management component. We also strengthened the multidisciplinary approach, the electronic registries of patients and the participation in both clinical research and research into health service provision. We really feel that the SWEET network plays a key role in the continuous improvement of paediatric diabetes care and we are proud of being part of it.
Meyer Children Hospital, Diabetologic Unit
Dr. Barbara Piccini
Meyer Children’s Hospital is a national model for children’s care with a multidisciplinary approach that combines healthcare with scientific research and teaching. Pediatric diabetology activity started at Meyer in the early 80s (with about 10 patients). In 1991 we became Tuscany Regional Centre for Pediatric Diabetology and as such we coordinate the pediatric diabetologic activities in Tuscany.
Our goal is to take care of children with diabetes and their families. The patient is at the centre of the care process and our aim is the empowerment of the patient/family. We have an outpatient clinic for T1DM, T2DM, new technologies and T1DM (CGMS, SAP), obesity, CFRD, MODY and monogenic diabetes. We follow also children at increased risk of DM (IGT, IFG, stress hyperglycemia, familiar cases of DM), we are consultants for adults with cystic fibrosis. We manage patients with DKA and complex cases of diabetes and the diabetologist is on emergency call 24H for hospitals and families.
We run group educational programs for CHO counting (dieticians), CSII course, new diagnosis course, management of diabetes at school (for teachers) and we hold meetings with teenagers about special issues such as sex, alcohol and drugs education. Moreover we run 7 fieldtrips per year for family and toddlers, primary school children and teenagers.
We care for about 800 patients with different type of diabetes, around 700 affected by T1DM. During the last 12 months we had 88 new patients. The head of the diabetology unit is Dr. Sonia Toni. Our team includes five full-time pediatric diabetologists and one part-time, three specialist nurses, one full-time dietician and one part-time, one part-time psychologist and one part-time social worker. We also have a part-time podiatrist in the team.
We would like to underline our patient centered model of care and our communication and educational programs. The strength of our diabetology unit comes from the multidisciplinary team and from the possibility to exchange ideas and motivation between the other specialist of the university hospital.
Moreover we are very proud of the global and continuous care we offer the patients from the beginning, when the diabetologist is immediately called in order to manage the DKA directly. We adhere to national and international guidelines for T1DM diagnosis, follow up and for the screening of comorbidities.
We are part of the diabetes study group of ISPED (Italian Society of Pediatric Endocrinology and Diabetology).
We became part of the SWEET network as Collaborative Centre in 2014 and we are currently applying to become Centre of Reference in 2015. Participating in the SWEET network represented for us the opportunity to start an international collaboration with other diabetologic units. Furthermore the possibility to share and compare our data and results was a challenge for us, providing the chance to take part in important research activities and collaborative initiatives to further research in diabetes.
We strongly believe that international collaborations and the SWEET network are the cornerstone for reaching a standardized high level of care for patients with diabetes.
Pediatric Diabetes Clinic, The Queen Silvia Children´s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
Prof. Dr. Gun Forsander
The Pediatric Diabetes Centre at the Queen Silvia Children´s Hospital, SahlgrenskaUniversityHospital in Gothenburg, Sweden, cares for around 500 children and adolescents with diabetes. The clinic serves all patients 0-18 years old in the region of Gothenburg. 97 % of the patients are diagnosed with Type 1 diabetes, the others with Type 2 diabetes, monogenetic diabetes, neonatal or secondary diabetes. All new patients are tested for HLA and diabetes specific antibodies to assure a correct diagnosis and treatment. Around 60 % of the patients are on insulin pump treatment. About half of the patients use CGM (continues glucose monitoring), either connected to the pump or as a separate system. The median HbA1c value of the patients at the clinic who are needing >0.5 U/day is 57.3 mmol/mol in Nov 2014, according to the day-by-day updated online Swedish Pediatric Diabetes Registry (SWEDIABKIDS). The diabetes team, consisting of 4 pediatric diabetologists (2.7 full-time), 4 diabetes specialized nurses, 2 dieticians (1.2 full-time), 1 psychologist (0.6 full-time) and 3 social workers (1.5 full-time) are working in accordance to ISPAD guidelines, SWEET guidelines and the Swedish National Pediatric Diabetes Guidelines. The research activity of the clinic is high with 15 peer reviewed publications during the last year. Members of the team are responsible for National diabetes team courses as well as National courses for paediatricians and National guidelines.
Being a part of SWEET study since 2008 and recognized as a SWEET CoR since 2011, our clinic has benefit a lot by the extended network all over Europe. The repeated meetings, creation of SWEET Guidelines and discussions on country differences in treatment traditions and options are stimulating and have led to further efforts to improve the pediatric diabetes care, both on a regional and national level. The opportunity to benchmarking the outcome data of different SWEET centres in Europe is very appreciated, also for the head of the hospital, who is very supportive to the new treatment possibilities.