The Stricter the Better? The Relationship between Targeted HbA1c Values and Metabolic Control of Pediatric Type 1 Diabetes Mellitus

الملخص EN

Introduction.

It remains unclear how H b A 1 c recommendations influence metabolic control of paediatric patients with type 1 diabetes mellitus.

To evaluate this we compared reported H b A 1 c with guideline thresholds.

Materials and Methods.

We searched systematically MEDLINE and EMBASE for studies reporting on H b A 1 c in children with T1DM and grouped them according to targeted H b A 1 c obtained from regional guidelines.

We assessed the discrepancies in the metabolic control between these groups by comparing mean H b A 1 c extracted from each study and the differences between actual and targeted H b A 1 c .

Results.

We included 105 from 1365 searched studies.

The median (IQR) H b A 1 c for the study population was 8.30% (8.00%–8.70%) and was lower in “6.5%” than in “7.5%” as targeted H b A 1 c level (8.20% (7.85%–8.57%) versus 8.40% (8.20%–8.80%); p = 0.028 ).

Median difference between actual and targeted H b A 1 c was 1.20% (0.80%–1.70%) and was higher in “6.5%” than in “7.5%” (1.70% (1.30%–2.07%) versus 0.90% (0.70%–1.30%), resp.; p < 0.001 ).

Conclusions.

Our study indicates that the 7.5% threshold results in H b A 1 c levels being closer to the therapeutic goal, but the actual values are still higher than those observed in the “6.5%” group.

A meta-analysis of raw data from national registries or a prospective study comparing both approaches is warranted as the next step to examine this subject further.