ESPE Yearbook of Paediatric Endocrinology

Pediatr Diabetes 2020;1–8. doi: 10.1111/pedi.13137

– As part of the SWEET initiative, the authors analyzed the clinical characteristics of 26,726 individuals with type 1 diabetes (T1D) aged < 21 years living in Europe, Asia/Middle East/Africa, Australia/New Zealand, North America and South America– Among patient care indicators, the percent of HbA1c < 7.5% ranged between regions from 18.1 to 46.3% and the percent of patients using pumps from 4.6 to 80.8%– Overall, there was a significant heterogeneity in diabetes care between regions

The SWEET project (www.sweet-project.org) consists in a network of pediatric diabetes centers worldwide. Its goal is to identify best practices and harmonize care to optimize outcomes in children and adolescents with diabetes mellitus. In this study, which includes for the first time centers from low-income countries, the authors conducted a baseline comparison among five SWEET regions across the world to assess differences in pediatric T1D care. Overall, the indicators of the Asia/Middle East/Africa region reflected poorer diabetes control compared to the other regions: higher median HbA1c (8.9% compared to an overall median of 8.0%), lower frequency of blood glucose monitoring (2.0/day compared to 4.1/day), lower % of HbA1c < 7.5% (18.1% compared to 34.9%), lower number of severe hypoglycemias (1.1/year compared to 1.3 per year). Surprisingly, the Asia/Middle East/Africa region was also associated with a daily dose of insulin (0.9 U/kg/d) that was higher compared to the dose in high income countries (0.8 U/kg/d), where diabetes control is better. However, the dose of insulin reported in this study is the dose that was prescribed. It may not reflect the dose of insulin that was actually injected. Indeed, the cost of insulin remains a major barrier to diabetes care in countries where it is not covered by the government or in centers that do not receive free insulin from organisations such as Life for a Child (LFAC) or Changing Diabetes in Children (CDiC). The study also shows that the % of children using pumps or intensified conventional therapy is much lower in Asia/Middle East/Africa compared to other regions. This difference may not be the primary cause for the poorer control observed in the low-income countries of the Asia/Middle East/Africa region. It is important to remember an article published by Ogle et al (and highlighted in the 2019 edition of the Yearbook): ‘intermediate care’, characterized by human insulin in a basal bolus regimen, access to blood glucose monitoring and to point-of-care HbA1c testing, diabetes education, basic complications screening, and access to experienced doctors and nurses are the key components of diabetes care and should be available in less-resourced countries (1).

References: 1. Ogle GD, von Oettingen JE, Middlehurst AC, Hanas R, Orchard TJ. Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels. Pediatr Diabetes. 2019;20:93–98. https://doi.org/10.1111/pedi.12801.