Optimal T1D pediatric care is hampered by heterogeneity in diabetes care systems across Europe. Centralized models with multidisciplinary approaches require more specialised care structures, taking into account demographic and geographical factors. ISPAD and ADA advocate that a minimum of 150 treated persons with T1D (PWDs) per organisation is required to build up sufficient experience and expertise for age-specific challenges. In the Netherlands it was previously shown that larger hospitals have higher technology-related diabetes care expenditures. This study, co-authored by Dick Mul and Theo Sas of Diabeter, aimed to to assess the association between hospital volume and hospital resource utilisation among Dutch children with T1D, focusing on hospitalisations, consultations, technology use and hospital expenditures.

This was a retrospective, nationwide cohort study, using administrative healthcare data of 5,082 children with diabetes mellitus treated in 44 Dutch hospitals across the country, grouped in three size categories: small (≥20–100 PWDs), medium (≥100–200 PWDs) and large (≥200 PWDs).

Key findings:

• Median age was 15 years (range 0–15 years), 52% male
• Number of PWDs per hospital: median 146 (range 30–402), 98% treated in secondary hospitals
• Fewer hospitalisations were observed in large hospitals compared with small hospitals
• Median number of yearly pediatrician visits was 7 in large and 6 in small hospitals (not significant)
• Although technology use varied between individual hospitals, there was no association between hospital volume and pump/CGM use
• Although there was much variation int total hospital costs, these were highest in medium-sized centres with €6,434 per PWD
• There were no significant differences in T1D care-related costs between hospitals with different PWD numbers

Concluding, the authors state

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