Improving diabetes care for children around the globe through international benchmarking
Global Diabetes Challenge The International Society for Pediatric and Adolescent Diabetes (ISPAD) has a very simple motto: “A better world for children with diabetes".
There are an estimated 500,000 children below the age of 15 years with diabetes around the world. It is a devastating disease in that an unknown number of die of diabetes even before they are diagnosed, and no child is cured from diabetes. To treat as well as possible, we need to stand on the followin 3 pillars; Science, Advocacy and Education.
Promising progress is done in research, but in everyday life with diabetes a good and effective care is needed. Diabetes is different in that the family and young person with diabetes does most of the work, but they need good training. Centers can learn from each other by benchmarking HbA1c (a measure of average blood glucose) and other variables, and share knowledge with those who achieve the best results.
ISPAD’s target for HbA1c in the pediatric age group below age 18 is below 58 mmol/mol (7.5%). Unfortunately we know from many studies, surveys and registers that the majority of children and adolescents do not meet this target. It is of course more difficult to treat to target in countries where resources are limited, and clinics are dependent upon donated insulin. But we find that also many centers in more resourceful countries still have problems in achieving these targets. Some countries have started registers that cover most centers in their territory like the UK, Germany, Austria, Denmark, Norway and Sweden, while others like the US have registers with partial coverage.
SWEET (www.sweet-project.eu) is a European initiative currently reaching out mainly to clinics with at least 150 patients with the aim to certify centers of excellence. It is encouraging to see how SWEET continues to grow with an increase in international representation also from outside of Europe.
As part of the ISPAD strategic document for 2015-2017, we have included a drive to have as many centers as possible begin collecting HbA1c and other data in a register. I truly believe that this is the best way forward for improving diabetes care for children around the globe. By comparing yourself with other centers, a very good discussion can arise locally, beginning to push towards a lower HbA1c with whatever resources you have available. ISPAD welcomes all centers treating children and adolescents with diabetes to join the benchmarking initiative to improve the outcome of our young people.
In this graph where each bar represents one pediatric diabetes clinic’s median HbA1c, data from national registers in England & Wales is combined with national Swedish data. This is the third year with a national UK register with 100% participation, while Sweden has done national benchmarking with 100% participation since 2007, and clearly benefitted from this process.
In this graph, data from SWEET and some international centers from the Life for a Child project (International Diabetes Federation, http://www.idf.org/lifeforachild) are added. It is evident that there are many determinators of achieved HbA1c results, and we can all improve by sharing our results in international benchmarking.