Background and Aims

The Hvidoere Childhood Diabetes Study Group has previously shown that a clear and consistent target setting by the diabetes team is strongly associated with HbA1c outcome in adolescents.

The aim of this study was to evaluate whether this finding can be confirmed, 14 years later, in children and adolescents from centres, that are part of an international diabetes registry, SWEET.

Methods

A questionnaire was sent out to 76 different SWEET centres across the world, of which a total of 53 paediatric centres were included (70%). The association between centre target value of HbA1c and mean HbA1c was adjusted for age, diabetes duration, sex, and gross domestic product.

Results

Of the 53 centres, 13.2% reported an HbA1c target between 6% and 6.5%, 32% had a target between >6.5% and 7%, 18.8% between >7% and 7.5 % and 3.8% between 8% and 8.5%. No specific target value was reported by 32.1% of all centres. Mean HbA1c across all centres (n=53) was 8.0 ± 1.0%. Adjusted regression analysis showed a positive association between HbA1c outcome and target value (p=0.005).

Conclusions

This international study demonstrates that a lower targeted HbA1c is associated with better metabolic control. It is unclear, whether low target values result in better metabolic control, or whether lower HbA1c values actually result in more ambitious target values. This target setting could play a role in explaining the differences in metabolic outcome between centres and could be a method to ameliorate this metabolic outcome.