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      Computer Programs and Datasheets

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          Despite modern treatment regimens, late complications in IDDM patients are still prevalent. Even in developed countries, a significant number of patients do not get the treatment which would be considered optimal based on the present state of medical knowledge. Quality documentation provides a successful approach to unmask deficits and to improve the outcome of care. Structural aspects as well as process and outcome indicators are different in pediatric diabetology compared to the care of adult patients. The German Working Group on Pediatric Diabetology has discussed and finalized a Statement on Quality Control, including specific parameters to be recorded prospectively in all patients. Under the auspices of the German Ministry of Health, a Computer Program designed for inpatient and outpatient care in pediatric diabetology was developed. Among many other features, internal and external quality control according to the guidelines of the German Working Group are facilitated by this approach, as no separate data entry is required. This program is now widely used among pediatric – as well as some adult – diabetes centers in Germany. Regular external comparisons of quality indicators are organized by the Working Group.

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          Glycosylated hemoglobin predicts the incidence and progression of diabetic retinopathy.

          The relationship between hyperglycemia, measured by glycosylated hemoglobin at the initial examination, and the four-year incidence and progression of diabetic retinopathy was examined in a population-based study in Wisconsin. Younger- (n = 891) and older-onset (n = 987) persons participating in baseline and follow-up examinations were included. Glycosylated hemoglobin was measured by microcolumn. Retinopathy was determined from stereoscopic fundus photographs. In the younger-onset group, comparing the highest with the lowest quartile of glycosylated hemoglobin, the relative risk for developing any diabetic retinopathy was 1.9; for proliferative retinopathy, 21.8; and for progression, 4.0. Among older-onset persons taking insulin, the corresponding relative risks were 1.9, 4.0, and 2.1. Among older-onset persons not taking insulin, relative risks were 4.0 for any retinopathy and 6.2 for progression. A positive relationship between incidence and progression of retinopathy and glycosylated hemoglobin remained after controlling for duration of diabetes, age, sex, and baseline retinopathy. These data suggest a strong and consistent relationship between hyperglycemia and incidence and progression of retinopathy.

            Author and article information

            Horm Res Paediatr
            Hormone Research in Paediatrics
            S. Karger AG
            July 1998
            17 November 2004
            : 50
            : Suppl 1
            : 68-73
            Department of Pediatrics, University of Ulm, Germany
            53108 Horm Res 1998;50(suppl 1):68–73
            © 1998 S. Karger AG, Basel

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            Page count
            Pages: 6
            Prevention of Complications. Assessment of the Quality of Care: Clinical and Technical Aspects


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