* Lower HbA1c targets are associated with better metabolic control.
- Previous studies have suggested that clear HbA1c target setting by the diabetes team is associated with HbA1c outcomes in adolescents. The aim of this study was to evaluate whether this finding is consistent in a larger cohort of children from centers participating in the SWEET international diabetes registry. A questionnaire was sent out to 76 SWEET centers, of which responses from 53 pediatric centers were included (70%). Descriptive outcomes were presented as median with lower and upper quartile. The association between the centers' target HbA1c and mean outcome HbA1c was calculated using linear regression adjusted for age, diabetes duration, sex, and gross domestic product. Median age of the children in the studied centers (n = 35,483) was 13.3 [12.6-14.6] years (49% female). Of the 53 centers, 13.2% reported an HbA1c target between 6.0 and 6.5%, 32.1% had a target between ≥ 6.0 and 7.0%, 18.9% between ≥ 7.0 and 7.5%, and 3.8% between ≥ 7.5 and 8.5%. No specific target value was reported by 32.1% of all centers. Median HbA1c across all centers was 7.9 [7.6-8.3] %. Adjusted regression analysis showed a positive association between HbA1c outcome and target HbA1c (p = 0.005).Conclusions: This international study demonstrated that a lower target for HbA1c was associated with better metabolic control. It is unclear whether low target values result in better metabolic control, or lower HbA1c values actually result in more ambitious target values. This target setting could contribute to the differences in HbA1c values between centers and could be an approach for improving metabolic outcomes. What is Known: • Target setting of HbA1c is important in children and adolescents with type 1 diabetes. • The optimal therapeutic approach of children with type 1 diabetes requires a trained multidisciplinary team. What is New: • Lower HbA1c targets are associated with better metabolic control. • No associations between the composition of the diabetes teams and metabolic control could be demonstrated.
* Parental presence during pediatric retrieval: the caregiver's perspective.
- The presence of family at the bedside of critically ill children is recommended, as part of "family-centered care." The studyaimed to understand if such recommendation was applied by our neonatal and pediatric retrieval team and the second aim was their perception of parental presence. We first conducted a 6-month monocentric prospective observational study where the transport teams had to rate parental presence after each retrieval. A second survey was filled out by all team members, to explore their perception of parental presence in a general manner, without referring to a specific transport. Three hundred seventeen questionnaires from the prospective survey were returned, with parents being present in the ambulance for 47% of retrievals. There was a significant difference in parental accompaniment between newborns (< 24 h) and older children. The parental presence was rated as neutral or positive for 99% of transportation, whereas approximately ¼ of the crew feared "a priori" parental presence during transport in the second survey.Conclusion: This study suggests at least one parent was present at almost half of the retrievals conducted in our sample during the study period. Very few negative experiences were reported in the prospective study by the caregivers who allowed parental presence. What is Known: •The concept of family-centered care is an approach that recognizes the importance of family engagement and involvement and encourages collaboration between families and healthcare professionals. •Parents wish to accompany their child. What is New: •The perception of parental presence, by transport team members, was neutral or positive in 99% of retrievals during the study. •Newborns' parents were less present during retrieval than older children's parents.