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World J Diabetes. Feb 15, 2015; 6(1): 1-7
Published online Feb 15, 2015. doi: 10.4239/wjd.v6.i1.1
One center in Brussels has consistently had the lowest HbA1c values in the 4 studies (1994-2009) by the Hvidoere International Study Group on Childhood Diabetes: What are the "recipes"?
Harry Dorchy
Harry Dorchy, Diabetology Clinic, University Children’s Hospital Queen Fabiola, Université Libre de Bruxelles, 1020 Brussels, Belgium
Author contributions: Dorchy H contributed to the manuscript.
Conflict-of-interest: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Harry Dorchy, MD, PhD, DHC, Professor, Diabetology Clinic, University Children’s Hospital Queen Fabiola, Avenue JJ Crocq 15, 1020 Brussels, Belgium. hdorchy@ulb.ac.be
Telephone: +32-2-4773185 Fax: +32-2-4773156
Received: August 23, 2014
Peer-review started: August 24, 2014
First decision: October 14, 2014
Revised: November 11, 2014
Accepted: December 16, 2014
Article in press: December 17, 2014
Published online: February 15, 2015
Abstract

The principal aims of therapeutic management of the child, adolescent and adult with type 1 diabetes are to allow good quality of life and to avoid long-term complications (retinopathy, neuropathy, nephropathy, cardiovascular disease, etc.) by maintaining blood glucose concentrations close to normal level. Glycated hemoglobin levels (HbA1c) provide a good criterion of overall glycemic control. The Hvidoere Study Group (HSG) on Childhood Diabetes, founded in 1994, is an international group representing about twenty highly experienced pediatric centers from Europe, North America, Japan and Australia. Four international comparisons of metabolic control (1995, 1998, 2005, 2009) have been performed. The one center that has consistently had the lowest HbA1c values (approximate 7.3% or 56.3 mmol/mol) is my center in Brussels. This is more often obtained with a twice-daily free-mixed regimen with additional supplemental fast insulins ad hoc. The so-called “Dorchy’s recipes” are summarized. The conclusion is that the number of daily insulin injections, 2 or ≥ 4, or the use of pumps, by itself does not necessarily give better results. Intensified therapy should not depend upon the number of insulin doses per day, by syringe, pen or pump but rather should be redefined as to intent-to-treat ascertainment (i.e., goals). When there are no mutually agreed upon goals for BG and/or HbA1c, when there is insufficient education and psychosocial support by the medical team or at home, there is likely to be poor outcomes, as shown by the HSG. One of our recipes is not to systematically replace rapid-acting human insulins by fast-acting analogues. Because the multicenter studies of the HSG, performed in developed countries without financial restriction, show that treatment of childhood diabetes is inadequate in general and that levels of HbA1c are very different, diabetes treatment teams should individually explore the reasons for failure, without any prejudice or bias. Any dogmatism must be avoided. Treatment cost vs results must also be taken into account.

Keywords: Type 1 diabetes mellitus, Insulin regimen, Diabetic children, Glycated hemoglobin, Conventional treatment, Intensive treatment

Core tip: Four international comparisons of the Glycated hemoglobin levels (HbA1c) levels (1995, 1998, 2005, 2009) have been performed by the Hvidoere Study Group on childhood diabetes in about twenty pediatric diabetology centers from about twenty industrialized countries in Europe, North America, Japan and Australia. The one center that has consistently had the lowest HbA1c values (approximate 7.3% or 56.3 mmol/mol) is my center in Brussels. This is more often obtained with a twice-daily free-mixed insulin regimen. The so-called “Dorchy’s recipes” are summarized.