The Australasian Diabetes Data Network: first national audit of children and adolescents with type 1 diabetes

Helen Phelan, Helen Clapin, Loren Bruns, Fergus J Cameron, Andrew M Cotterill, Jennifer J Couper, Elizabeth A Davis, Kim C Donaghue, Craig A Jefferies, Bruce R King, Richard O Sinnott, Elaine B Tham, Jerry K Wales, Timothy W Jones and Maria E Craig
Med J Aust 2017; 206 (3): 121-125. || doi: 10.5694/mja16.00737


Objectives: To assess glycaemic control, anthropometry and insulin regimens in a national sample of Australian children and adolescents with type 1 diabetes.

Design: Cross-sectional analysis of de-identified, prospectively collected data from the Australasian Diabetes Data Network (ADDN) registry.

Setting: Five paediatric diabetes centres in New South Wales, Queensland, South Australia, Victoria and Western Australia.

Participants: Children and adolescents (aged 18 years or under) with type 1 diabetes of at least 12 months’ duration for whom data were added to the ADDN registry during 2015.

Main outcome measures: Glycaemic control was assessed by measuring haemoglobin A1c (HbA1c) levels. Body mass index standard deviation scores (BMI-SDS) were calculated according to the CDC-2000 reference; overweight and obesity were defined by International Obesity Task Force guidelines. Insulin regimens were classified as twice-daily injections (BD), multiple daily injections (MDI; at least three injection times per day), or continuous subcutaneous insulin infusion (CSII).

Results: The mean age of the 3279 participants was 12.8 years (SD, 3.7), mean diabetes duration was 5.7 years (SD, 3.7), and mean HbA1c level 67 mmol/mol (SD, 15); only 27% achieved the national HbA1c target of less than 58 mmol/mol. The mean HbA1c level was lower in children under 6 (63 mmol/mol) than in adolescents (14–18 years; 69 mmol/mol). Mean BMI-SDS for all participants was 0.6 (SD, 0.9); 33% of the participants were overweight or obese. 44% were treated with CSII, 38% with MDI, 18% with BD.

Conclusions: Most Australian children and adolescents with type 1 diabetes are not meeting the recognised HbA1c target. The prevalence of overweight and obesity is high. There is an urgent need to identify barriers to achieving optimal glycaemic control in this population.

Please login with your free MJA account to view this article in full

  • Helen Phelan1,2
  • Helen Clapin3,4
  • Loren Bruns5
  • Fergus J Cameron6
  • Andrew M Cotterill7,8
  • Jennifer J Couper9
  • Elizabeth A Davis10
  • Kim C Donaghue11
  • Craig A Jefferies12
  • Bruce R King1
  • Richard O Sinnott5
  • Elaine B Tham9
  • Jerry K Wales7,8
  • Timothy W Jones10
  • Maria E Craig2,11

  • 1 John Hunter Children's Hospital, Newcastle, NSW
  • 2 University of Sydney, Sydney, NSW
  • 3 Telethon Kids, Perth, WA
  • 4 Australasian Paediatric Endocrine Group, Australasian Diabetes Data Network, Lake Macquarie, NSW
  • 5 University of Melbourne, Melbourne, VIC
  • 6 Royal Children's Hospital, Melbourne, VIC
  • 7 Lady Cilento Children's Hospital, Brisbane, QLD
  • 8 University of Queensland, Brisbane, QLD
  • 9 Women's and Children's Hospital, Adelaide, SA
  • 10 Princess Margaret Hospital for Children, Perth, WA
  • 11 The Children's Hospital at Westmead, Sydney, NSW
  • 12 The Starship Children's Hospital, Auckland, New Zealand



This research was supported by the Australian Type 1 Diabetes Clinical Research Network, led by Juvenile Diabetes Research Foundation (JDRF) Australia, with additional funding by the Australian Research Council (through a Special Research Initiative) and the federal Department of Health and Ageing. Helen Phelan received a National Health and Medical Research Council (NHMRC) Public Health and Health Services Research Scholarship. We thank the staff of the JDRF Australian Type 1 Clinical Research Network, particularly Dorota Pawlak and Maryanne Ng, for ongoing support and guidance. We gratefully acknowledge the contribution and support of the Australasian Paediatric Endocrine Group (APEG) and Lyndell Wills, APEG Secretariat, and we also thank Albert Chan, Children’s Hospital Westmead, Sydney, and Girard Good, Telethon Kids Institute, Perth, for developing the clinical database and preparing data exports to the ADDN.

Competing interests:

No relevant disclosures.

  • 1. McKnight JA, Wild SH, Lamb MJ, et al. Glycaemic control of type 1 diabetes in clinical practice early in the 21st century: an international comparison. Diabet Med 2015; 32: 1036-1050.
  • 2. Rewers MJ, Pillay K, de Beaufort C, et al; International Society for Pediatric and Adolescent Diabetes. ISPAD Clinical Practice Consensus Guidelines 2014. Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatr Diabetes 2014; 15 Suppl 20: 102-114.
  • 3. Craig ME, Twigg SM, Donaghue KC, et al; for the Australian Type 1 Diabetes Guidelines Expert Advisory Group. National evidence-based clinical care guidelines for type 1 diabetes in children, adolescents and adults. Canberra: Australian Government. Department of Health and Ageing, 2011. (accessed Mar 2016).
  • 4. Rosenbauer J, Dost A, Karges B, et al; DPV initiative and the German BMBF Competence Network Diabetes Mellitus. Improved metabolic control in children and adolescents with type 1 diabetes: a trend analysis using prospective multicenter data from Germany and Austria. Diabetes Care 2012; 35: 80-86.
  • 5. Peterson A, Hanberger L, Akesson K, et al. Improved results in paediatric diabetes care using a quality registry in an improvement collaborative: a case study in Sweden. PLoS One 2014; 9: e97875.
  • 6. Catanzariti L, Faulks K, Moon L, et al. Australia’s national trends in the incidence of Type 1 diabetes in 0–14-year-olds, 2000–2006. Diabet Med 2009; 26: 596-601.
  • 7. Thomsett M, Shield G, Batch J, et al. How well are we doing? Metabolic control in patients with diabetes. J Paediatr Child Health 1999; 35: 479-482.
  • 8. Cameron FJ, Clarke C, Hesketh K, et al. Regional and urban Victorian diabetic youth: clinical and quality-of-life outcomes. J Paediatr Child Health 2002; 38: 593-596.
  • 9. Cooper MN, O’Connell SM, Davis EA, et al. A population-based study of risk factors for severe hypoglycaemia in a contemporary cohort of childhood-onset type 1 diabetes. Diabetologia 2013; 56: 2164-2170.
  • 10. Downie E, Craig ME, Hing S, et al. Continued reduction in the prevalence of retinopathy in adolescents with type 1 diabetes: role of insulin therapy and glycemic control. Diabetes Care 2011; 34: 2368-2373.
  • 11. Cameron FJ, Couper JJ, Craig ME, et al. Care for children and adolescents with diabetes in Australia and New Zealand: Have we achieved the defined goals? J Paediatr Child Health 2013; 49: E258-E262.
  • 12. Clapin H, Phelan H, Bruns L, et al; on behalf of the Australasian Diabetes Data Network (ADDN) Study Group. Australasian Diabetes Data Network: building a collaborative resource. J Diabetes Sci Technol 2016; 10: 1015-1026.
  • 13. Centers for Disease Control and Prevention, National Center for Health Statistics. CDC growth charts [website]. (accessed Nov 2016).
  • 14. Cole TJ, Belizzi MC, Flegal KM, et al. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240-1243.
  • 15. Miller KM, Foster NC, Beck RW, et al; for the T1D Exchange Clinic Network. Current state of type 1 diabetes treatment in the US: updated data from the T1D Exchange Clinic Registry. Diabetes Care 2015; 38: 971-978.
  • 16. Stone ML, Craig ME, Chan AK, et al. Natural history and risk factors for microalbuminuira in adolescents with type 1 diabetes: a longitudinal study. Diabetes Care 2006; 29: 2072-2077.
  • 17. Craig ME, Handelsman P, Donaghue KC, et al. Predictors of glycaemic control and hypoglycaemia in children and adolescents with type 1 diabetes from NSW and the ACT. Med J Aust 2002; 177: 235-238. <MJA full text>
  • 18. Perry L, Steinbeck KS, Dunbabin JS, et al. Lost in transition? Access to and uptake of adult health services and outcomes for young people with type 1 diabetes in regional New South Wales. Med J Aust 2010; 193:444-449. <MJA full text>
  • 19. Khanolkar AR, Amin R, Taylor-Robinson D, et al. Young people with type 1 diabetes of non-white ethnicity and lower socio-economic status have poorer glycaemic control in England and Wales. Diabet Med 2016; 33:1508-1515.
  • 20. Driskell O, Holland D, Waldron J, et al. Reduced testing frequency for glycated hemoglobin, HbA1c, is associated with deteriorating diabetes control. Diabetes Care 2014; 37: 2731-2737.
  • 21. Marks A, Wilson V, Crisp J. The management of type 1 diabetes in Australian primary schools. Issues Compr Pediatr Nurs 2014; 37: 168-182.
  • 22. Sherr JL, Hermann JM, Campbell F, et al; for the T1D Exchange, the DPV Initiative, and the NPDA and the RCP and Child Health registries. Use of insulin pump therapy in children and adolescents with type 1 diabetes and its impact on metabolic control: comparison of results from three large, transatlantic paediatric registries. Diabetologia 2016; 59: 87-91.
  • 23. Johnson SR, Cooper MN, Jones TW, et al. Long-term outcome of insulin pump therapy in children with type 1 diabetes assessed in a large population-based case-control study. Diabetologia 2013; 56: 2392-2400.
  • 24. Australian Bureau of Statistics. 4364.0.55.003. Australian Health Survey: updated results, 2011–2012 [website]. June 2013. (accessed Mar 2016).
  • 25. Islam ST, Abraham A, Donaghue KC, et al. Plateau of adiposity in Australian children diagnosed with type 1 diabetes: a 20-year study. Diabet Med 2014; 31: 686-690.
  • 26. O’Connell MA, Donath S, Cameron FJ. Major increase in type 1 diabetes: no support for the accelerator hypothesis. Diabet Med 2007; 24: 920-923.
  • 27. DuBose S, Hermann J, Tamborlane W, et al. Obesity in youth with type 1 diabetes in Germany, Austria and the United States. J Pediatr 2015; 167: 627-632.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.