ISPAD Clinical Practice Consensus Guidelines, Compendium. Assessment and monitoring of glycemic control in children and adolescents with diabetes

Barbara Davis Center, University of Colorado Denver, Aurora, CO 80045-6511, USA.
Pediatric Diabetes (Impact Factor: 2.57). 09/2009; 10 Suppl 12(6):71-81. DOI: 10.1111/j.1399-5448.2009.00582.x
Source: PubMed


In addition to the IFCC Working Group, an IFFC/ ADA/EASD/IDF Working Group was formed, now with representation from Juvenile Diabetes Research Foundation International. This group has been focused on implementing an international study to document what the clinical world has always thought to be true but never proven: that the A1c assay does indeed reflect an average BG over many months. If the direct relationship can be documented, then the reporting of the assay would include an ’estimated average blood glucose’, or 'A1c-derived average glucose (ADAG)’, and the units would be in mmol/L (or mg/dL) (93, 94). IFFC/ADA/EASD/IDF has issued a Consensus statement (91), with which the Guideline editors agree, stating (i) A1c test results should be standardized worldwide, including the reference system and results reporting; (ii) the new IFCC reference system for A1c represents the only valid anchor to implement standardization of the measurement; (iii) A1c results are to be reported worldwide in derived National Glycohemoglobin Standardization Program (NGSP) units (%) using the NGSP-IFCC master equation and IFCC units (mmol/mol) (Note: this transaction will most likely occur over several years.); (iv) if the ongoing ’average plasma glucose study’ fulfills it's a priori specified criteria, an ADAG value calculated from the A1c result will also be reported as an interpretation of the A1c results; and (v) glycemic goals appearing in clinical guidelines should be expressed in IFCC units, derived NGSP units, and ADAG.

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Available from: Peter Swift, Mar 11, 2014
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    • "The Diabetes Control and Complications Trial (DCCT) and the follow-up Epidemiology of Diabetes Intervention and Complications Study (EDIC) confirmed that intensive insulin treatment could improve glycemic control, reducing or delaying the long-term complications of T1DM, with a persistent benefit [1] [2] [3]. Since these results were published, intensive insulin therapy has been widely applied in clinical practice, almost becoming the standard of care [4] [5] [6]. However, in contrast to the DCCT and EDIC findings, Holl et al. [7] found that the use of intensive therapy did not improve glucose control in clinical practice in 17 European countries. "
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    ABSTRACT: Aims. To determine whether multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII) contributes to better glucose control in children with different type 1 diabetes duration. Methods. Subjects were grouped according to early (≤1 year after disease onset; 1A) or late (1-3 years after onset; 2A) MDIs/CSII treatment initiation. Corresponding control groups (1B, 2B) received insulin injections twice daily. Results. HbA1c levels were consistently lower in group 1A than in group 1B (6 months (T2): 7.37% versus 8.21%; 12 months (T3): 7.61% versus 8.41%; 24/36 months (T4/T5): 7.61% versus 8.72%; all P < 0.05), but were lower in group 2A than in group 2B only at T2 (8.36% versus 9.19%; P = 0.04). Levels were lower in group 1A than in group 2A when disease duration was matched (7.61% versus 8.49%; P < 0.05). Logistic regression revealed no correlation between HbA1c level and MDIs/CSII therapy. HbA1c levels were only negatively related to insulin dosage. Conclusions. Blood glucose control was better in patients receiving MDIs/CSII than in those receiving conventional treatment. Early MDIs/CSII initiation resulted in prolonged maintenance of low HbA1c levels compared with late initiation. MDIs/CSII therapy should be combined with comprehensive management.
    Full-text · Article · Aug 2014 · International Journal of Endocrinology
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    • "In our sample, 59.7% of the children had HbA1c levels above the recommended ISPAD guideline of 58 mmol/mol or 7.5% [44]. This is in line with a recent large-scale European study [45] where 58% of the 27.035 participating children had a suboptimal HbA1c level. "
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    ABSTRACT: Background In young children with type 1 diabetes mellitus (T1DM), parents have complete responsibility for the diabetes-management. In toddlers and (pre)schoolers, the tasks needed to achieve optimal blood glucose control may interfere with normal developmental processes and could negatively affect the quality of parent–child interaction. Several observational instruments are available to measure the quality of the parent–child interaction. However, no observational instrument for diabetes-specific situations is available. Therefore, the aim of the present study was to develop a qualitative observation instrument, to be able to assess parent–child interaction during diabetes-specific situations. Methods First, in a pilot study (n = 15), the observation instrument was developed in four steps: (a) defining relevant diabetes-specific situations; (b) videotaping these situations; (c) describing all behaviors in a qualitative observation instrument; (d) evaluating usability and reliability. Next, we examined preliminary validity (total n = 77) by testing hypotheses about correlations between the observation instrument for diabetes-specific situations, a generic observation instrument and a behavioral questionnaire. Results The observation instrument to assess parent–child interaction during diabetes-specific situations, which consists of ten domains: “emotional involvement”, “limit setting”, “respect for autonomy”, “quality of instruction”, “negative behavior”, “avoidance”, “cooperative behavior”, “child’s response to injection”, “emphasis on diabetes”, and “mealtime structure”, was developed for use during a mealtime situation (including glucose monitoring and insulin administration). Conclusions The present study showed encouraging indications for the usability and inter-rater reliability (weighted kappa was 0.73) of the qualitative observation instrument. Furthermore, promising indications for the preliminary validity of the observation instrument for diabetes-specific situations were found (r ranged between |.24| and |.45| for significant correlations and between |.10| and |.23| for non-significant trends). This observation instrument could be used in future research to (a) test whether parent–child interactions are associated with outcomes (like HbA1c levels and psychosocial functioning), and (b) evaluate interventions, aimed at optimizing the quality of parent–child interactions in families with a young child with T1DM.
    Full-text · Article · Jun 2014 · BMC Pediatrics
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    • "Strengths include the qualitative approach with its focus on the lived experience of adolescents, the mix of qualitative methods used, and the attention to interaction with friends. A limitation is that the research population was small and had relatively good blood glucose levels [23]. Adolescents who experience greater difficulty with their diabetes self-management may be less open about their diabetes and less likely to participate in research of this kind. "
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    ABSTRACT: Self-management of diabetes is challenging, especially for adolescents who face multiple changes, including closer peer relationships. Few studies have explored how friends can provide constructive support in this effort. The present research investigated, in two qualitative studies, the perceptions of adolescents with diabetes and their friends with respect to the positive social support that friends can offer. In study 1, 28 adolescents aged 12-15 with type 1 diabetes participated in online focus groups. In study 2, 11 of these adolescents were interviewed in person together with their best friends. The data were analysed by means of content analysis. In study 1, the adolescents with diabetes identified various supportive behaviours of friends, particularly concerning emotional support: treating them normally, showing interest, having fun, providing a distraction, and taking their diabetes into account. They differed in their attitude towards support, and this influenced which behaviours they perceived as supportive. Study 2 showed that the adolescents with diabetes and their friends often had similar opinions on the desired degree of support. Fear of stigmatization and sense of autonomy withheld some adolescents with diabetes from soliciting more support. These insights can be useful in patient education aiming to promote social support.
    Full-text · Article · Jan 2014
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