title: The Stricter the Better? The Relationship between Targeted HbA1c Values and Metabolic Control of Pediatric Type 1 Diabetes Mellitus.
abstract: BACKGROUND
  It remains unclear how HbA1c recommendations influence metabolic control of paediatric patients with type 1 diabetes mellitus. To evaluate this we compared reported HbA1c with guideline thresholds.
  
  
  METHODS
  We searched systematically MEDLINE and EMBASE for studies reporting on HbA1c in children with T1DM and grouped them according to targeted HbA1c obtained from regional guidelines. We assessed the discrepancies in the metabolic control between these groups by comparing mean HbA1c extracted from each study and the differences between actual and targeted HbA1c.
  
  
  RESULTS
  We included 105 from 1365 searched studies. The median (IQR) HbA1c for the study population was 8.30% (8.00%-8.70%) and was lower in "6.5%" than in "7.5%" as targeted HbA1c level (8.20% (7.85%-8.57%) versus 8.40% (8.20%-8.80%); p = 0.028). Median difference between actual and targeted HbA1c 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 HbA1c 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.
authors.affiliation: Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Braun
authors.affiliation: Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland.
authors.forename: Bartlomiej
authors.initials: B
authors.lastname: Tomasik
authors.affiliation: Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Wrona
authors.affiliation: Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Fendler
authors.affiliation: Department of Pediatrics, Endocrinology and Diabetology, Medical University of Silesia, Medykow 16, 40-752 Katowice, Poland.
authors.forename: Przemyslawa
authors.initials: P
authors.lastname: Jarosz-Chobot
authors.affiliation: Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Szadkowska
authors.affiliation: Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Zmysłowska
authors.affiliation: Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Vincent Drive, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Jayne
authors.initials: J
authors.lastname: Wilson
authors.affiliation: Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Mlynarski
mesh_terms: D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D006442:Glycated Hemoglobin / Q000378:metabolism* / Q000592:standards; D006801:Humans; D015999:Multivariate Analysis; D010372:Pediatrics / Q000592:standards; D017410:Practice Guidelines as Topic; D012107:Research Design; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human