Children with type 1 diabetes have similar long-term blood sugar control whether they get their initial diabetes education at a university hospital or a community hospital, a new study shows. The results will be presented Sunday, June 15, at The Endocrine Society’s 90th Annual Meeting in San Francisco.

“Ongoing diabetes education for the patient and family is likely more important than the education provided at the time of diagnosis,” said Emily Walvoord, MD, assistant clinical professor of pediatric endocrinology at Indiana University and a study coauthor.

At Indiana University’s Riley Hospital for Children, children with a new diagnosis of type 1 diabetes and their families go through an intensive, three-day inpatient program with a certified diabetes educator. The program is certified by the American Diabetes Association. Children who are diagnosed and educated at other hospitals, and who transfer to Riley’s diabetes program, receive a half-day of basic diabetes education.

The authors compared a group of 81 children who transferred to Riley after receiving their original diabetes instruction at a non-university hospital with 81 children whose initial education took place at the university hospital. The average age of the children was 6.5 years. There were no differences between the two groups in parental education, marital status or type of insurance, the authors reported.

Follow-up care was the same for all 162 children. It consisted of frequent phone calls and adjustments to insulin treatment by diabetes nurses, a yearly meeting with a dietitian and visits with the physician every three to four months, Walvoord said.

At two, three, and five years after diagnosis, the patients had a test of their hemoglobin A1c, a measure of long-term glycemic, or blood sugar, control.

“We expected to see a clear improvement in glycemic control in children who received their initial diabetes education at our university hospital,” Walvoord said. “But that wasn’t the case.”

Five years after diagnosis, children who received their initial diabetes education at non-university hospitals had better glycemic control than the other group, the study found. That is, they had a lower average A1c level: 8.3 percent versus 9.1 percent. Only at three years did the children who started in the university program have better blood sugar control compared with the referred patients.

The reason for the unexpected result is unclear, Walvoord said. She speculated that the referring physicians may have suggested that families strive for a stricter target A1c than what the Riley program recommends. There are no set hemoglobin A1c guidelines for children, as there are for adults, she explained. They vary from center to center and by the child’s age.

The message for parents is this, Walvoord said: “The setting where families get their initial diabetes education may not be as critical as getting ongoing education.”

She also recommended that parents be active in their child’s diabetes care.

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Founded in 1916, The Endocrine Society is the world's oldest, largest, and most active organization devoted to research on hormones and the clinical practice of endocrinology. Today, The Endocrine Society's membership consists of over 14,000 scientists, physicians, educators, nurses and students in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Md. To learn more about the Society, and the field of endocrinology, visit our web site at www.endo-society.org.