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"?

Table 1 HbA1c comparisons in the 4 studies by the Hvidoere international study group on childhood diabetes (1995-2009)

Hvidoere studies	Number of countries of pediatric centers	Numberof subjects	Age (yr)	Mean HbA1c (%) ± SD (mean DCCT aligned)	Spread in center mean HbA1C (%) (DCCT aligned)	Conclusions
1995[8]	18 (Europe, North America, Japan) 22	2873	0-18	8.6 ± 1.7 (8.3)	7.6-10.2 (7.3-9.9)	No difference in glycemic control was found among adolescents treated with two, three, and four or more daily injections. Girls on 4 injections had higher BMI
1998[2]	17 (Europe, North America, Japan) 21	2101	11-18	8.7 ± 1.7 (8.4)	7.7-10.1 (7.4-9.8)	The differences between centers were not explicable by differences in insulin regimens. The centers with the lowest mean HbA1c also had lowest rates of severe hypoglycemia and reported better QOL
2005[9]	19 (Europe, North America, Japan, Australia) 21	2093	11-18	8.6 ± 1.7 (8.2)	7.7-9.5 (7.4-9.2)	Intensified insulin regimens (MDI and CSII) showed no lower HbA1c compared with twice daily free-mixing (lowest HbA1c)
2009[10]	17 (Europe, North America, Japan, Australia) 18	1113	< 11	8.3 ± 1.3 (8.0)	7.6-9.2 (7.3-8.9)	despite major changes in management (> 99% on analog insulins and 33% with CSII), the lowest HbA1c levels were found in the twice daily free-mixing insulin regimen in Brussels (7.3% ± 0.5%)

MDI: Multidose insulin; CSII: Continuous subcutaneous insulin infusion.