In the last decades, HbA1c levels in young diabetic patients have decreased. However differences in metabolic control still exists between pediatric diabetes centers (PDC) [1-2].
Few studies have been undertaken to explain the between-center HbA1c differences. Nevertheless we know that the metabolic control is not only dependent on the treatment prescribed but also on other factors such as biological, socio-demographic and psychosocial factors which are beyond the control of care providers and may be different between centers .
Thus a "simple" comparison of HbA1c does not reflect the real differences of the quality of care given by different centers. In order to have a proper comparison, consideration must be taken for those external factors’ impact on HbA1c levels (i.e. risk-adjustment).
Based on a pilot project, we wanted to identify psychosocial factors of which PDCs thought that they can positively or negatively influence the level of HbA1c in type 1 diabetes during childhood and adolescence. The factors that PDCs scored highly are potential factors which should be corrected for when mean HbA1c is compared between centers.
High parental responsability and family support were scored as the most important contributing factors for EH. - A wider set of factors scored highly with regard to PH. But parental responsibility and family support remained among the highest ranking contributors, together with adolescence. - When a known risk factor for PH was present (e.g. adolescence), PDCs also scored this factor highly. - A qualitative analysis of free-text reasons for EH and PH provided information on how to improve the questionnaire for future studies (items on motivation and comorbidities). - There is evidence that due to the relatively low participation rate, the results may not be representative for all Belgian patients.