Diabetes in children; a global comparative study

Aims The aim of this study was to explore if international guidelines concerning diabetes care for children are followed, and if they are not, why, and how practice is different from the international recommendations. Methods As part of their compulsory student thesis, medical students from the University of Oslo, Norway, made a standardized questionnaire based upon the International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines from 2009. A total of 16 hospitals in eight countries, six continents, were visited. Diabetes care in children was observed, and personnel at the hospitals were interviewed semi structured, based on the questionnaire. Results Out of 16 hospitals visited, all but the hospital in Rwanda reported that they used guidelines in their care for children with diabetes. Some used national guidelines, but these were quite similar to the ISPAD guidelines. Lack of medical equipment would make it hard to follow guidelines in Rwanda even if tried. The proportion of children with diabetic ketoacidosis at diagnosis varied from six to 100%. All hospitals but the one in Rwanda used treatment goals measured in glycosylated hemoglobin. The amount of patients reaching the treatment goal varied from 9-65%. Countries without registries for incidence and complications generally reported a higher rate of success in diabetes care. At the same time some reported treating children with late diabetes complications. Conclusions How the ISPAD guidelines are adhered to varies among different hospitals in different parts of the world. Guidelines give however, objective criteria for registering which again can, via benchmarking and increased awareness, improve diabetes care for children internationally