title: Children's and adolescent's self - assessment of metabolic control versus professional judgment: a cross-sectional retrospective and prospective cohort study.
abstract: BACKGROUND
  Morbidity and mortality in T1DM depend on metabolic control, which is assessed by HbA1c measurements every 3-4 months. Patients' self-perception of glycemic control depends on daily blood glucose monitoring. Little is known about the congruence of patients' and professionals' perception of metabolic control in T1DM.
  
  
  OBJECTIVE
  To assess the actual patients' self-perception and objective assessment (HbA1c) of metabolic control in T1DM children and adolescents and to investigate the possible factors involved in any difference.
  
  
  METHODS
  Patients with T1DM aged 8 - 18 years were recruited in a cross-sectional, retrospective and prospective cohort study. Data collection consisted of clinical details, measured HbA1c, self-monitored blood glucose values and questionnaires assessing self and professionals' judgment of metabolic control.
  
  
  RESULTS
  91 patients participated. Mean HbA1c was 8.03%. HbA1c was higher in patients with a diabetes duration > 2 years (p = 0.025) and in patients of lower socioeconomic level (p = 0.032). No significant correlation was found for self-perception of metabolic control in well and poorly controlled patients. We found a trend towards false-positive memory of the last HbA1c in patients with a HbA1c > 8.5% (p = 0.069) but no difference in patients' knowledge on target HbA1c between well and poorly controlled patients.
  
  
  CONCLUSIONS
  T1DM patients are aware of a target HbA1c representing good metabolic control. Ill controlled patients appear to have a poorer recollection of their HbA1c. Self-perception of actual metabolic control is similar in well and poorly controlled T1DM children and adolescents. Therefore, professionals should pay special attention that ill controlled T1DM patients perceive their HbA1c correctly.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bieri
authors.forename: Monika
authors.initials: M
authors.lastname: Oser-Meier
authors.forename: Marco
authors.initials: M
authors.lastname: Janner
authors.forename: Chantal
authors.initials: C
authors.lastname: Cripe-Mamie
authors.forename: Kathrin
authors.initials: K
authors.lastname: Pipczynski-Suter
authors.forename: Primus E
authors.initials: PE
authors.lastname: Mullis
authors.affiliation: Pediatric Endocrinology, Diabetology & Metabolism, University Children's Hospital, Inselspital, Freiburgstrasse 15, CH - 3010 Bern, Switzerland. christa.flueck@dkf.unibe.ch.
authors.forename: Christa E
authors.initials: CE
authors.lastname: Flück