ESPEYB19 13. Global Health for the Paediatric Endocrinologist Diabetes (6 abstracts)
13.10. Hemoglobin A1c trajectories in the first 18 months after diabetes diagnosis in the SWEET diabetes registry
Prahalad P , Schwandt A , Besançon S , Mohan M , Obermannova B , Kershaw M , Bonfanti R , Pundziute Lyckå A , Hanas R , Casteels K & the SWEET Study Group
Division of Pediatric Endocrinology, Stanford University and Stanford Diabetes Research Center, Stanford, California, USA
prahalad@stanford.edu Pediatr Diabetes 2022; 23: 228–236. doi: 10.1111/pedi.13278
Brief Summary: Analysis of the multi-national SWEET diabetes registry showed that mean HbA1c in youth is highest at diagnosis and lowest at 4 to 5 months post-diagnosis. The HbA1c trajectory was lower in countries with nationalized health insurance. High gross domestic product (GDP) and high use of technology did not seem to protect from a higher trajectory.
To identify characteristics associated with glycemic control in youth with T1D, the authors analyzed data from the SWEET diabetes registry, a multi-national registry of youth with diabetes. 55 centers, divided into 4 regions, participated. Several centers, including India, Mali, Mauritius and Turkey, were located in low- and middle-income countries (LMICs). All centers had one point in common: HbA1c was lowest at 4–5 months after diagnosis. However, several differences between regions are of interest, although the relationship between HbA1c and regional characteristics was not always clear.
First, the region that included countries with the lowest GDP (South America, Asia, Middle East, Africa) also had a lower average HbA1c and a higher insulin total daily dose during the first 18 months compared to Southern Europe, North America, Australia and New Zealand. However, lower GDP was also associated with lower use of insulin pumps and continuous blood glucose monitoring, suggesting that technology per se does not necessarily lead to better metabolic control. In addition, countries with lower GDP were less likely to offer a national health insurance scheme, usually associated with better outcomes. Interpretation was limited by the lack of information on many potential confounding factors, and uncertainty if the participating center is representative of the country? Does the prescribed insulin dose reflect the actual amount used by the patient? Nevertheless, analysis of the SWEET data provides precious information, and it is suggested that more centers in LMICs should join this registry.
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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