Comparable glycemic outcomes for pediatric type 1 diabetes patients in metropolitan and non-metropolitan regions of Western Australia: A population-based study

Pediatr Diabetes. 2018 May;19(3):486-492. doi: 10.1111/pedi.12550. Epub 2017 Jun 30.


Background: Pediatric patients diagnosed with type 1 diabetes (T1D) in Western Australia (WA) are managed by a single, specialist multidisciplinary diabetes service based at a central tertiary hospital in the capital city, Perth, which provides outreach care in regional centers.

Objective: To investigate the hypothesis that outcomes for a contemporary, population-based pediatric T1D cohort, managed by a single tertiary service are similar for metropolitan and non-metropolitan patients using this model of care. To confirm that the cohort is indeed population based, a secondary aim of the study was to determine the case ascertainment of the Western Australian Children's Diabetes Database (WACDD).

Methods: Data for all T1D patients aged <18 years, who attended the diabetes clinics (metropolitan and non-metropolitan), at least once in 2014, were extracted from the WACDD and outcomes including HbA1c and severe hypoglycemia (SH) rates analyzed.

Results: In 2014, a total of 1017 patients (492 females, 525 males) attended the diabetes clinics (54% metropolitan and 46% non-metropolitan). After adjusting for age, sex, diabetes duration, and insulin regimen, region of clinic was not a significant predictor of mean HbA1c or SH rate. The case ascertainment of the WACDD was estimated to be 99.9% complete for children diagnosed with T1D aged <15 years between 2002 and 2012.

Conclusions: This study reports similar glycemic outcomes for patients attending diabetes clinics in metropolitan and non-metropolitan areas of WA, suggesting that a model of care provided as outreach from a specialized diabetes service is effective in achieving equitable glycemic outcomes.

Keywords: centralized service; children; glycemic outcome; region; type 1 diabetes.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Child
  • Cohort Studies
  • Diabetes Mellitus, Type 1 / therapy*
  • Diabetic Ketoacidosis / epidemiology
  • Female
  • Humans
  • Hypoglycemia / epidemiology
  • Male
  • Rural Health Services / statistics & numerical data*
  • Urban Health Services / statistics & numerical data*
  • Western Australia / epidemiology