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Objectives HbA1c (Glycated Haemoglobin) is crucial for monitoring children with diabetes mellitus (DM). The RCPCH paediatric diabetes quality programme's key measure is for all units to have a high HbA1c pathway1 but there is little published evidence to support what steps should be on the pathway, and whether they work in clinical practice. Objectives To compare the HbA1c levels in children on the High HbA1C Pathway (enrolled between January – September 2021) with equivalent Controls (fulfilling similar criteria but without a formal pathway between January 2019 – August 2020). To identify any modifiable factors of greatest influence. Methods The high HbA1c pathway (figure 1 shows the local high HbA1c pathway) introduced in January 2021 included patients with type 1 DM on treatment for >6 months with a new increase of HbA1c≥70 mmol/mol (9 patients enrolled between Jan-Sept 2021). The control group (10 patients) was identified from medical records as meeting the same criteria 2 years before the pathway was initiated (Jan 2019-Aug 2020). HbA1c values at 6 months pre-pathway initiation (point -6), start point 0 (HbA1c≥70), and at 12 and 24 months later (+12 and +24) for both groups were collected. Other factors, such as gender, ethnicity, and the use of pumps or continuous glucose monitors (CGM) at the 0- and 1-year marks, were also examined. Comparison and statistical analysis of the data between both groups were conducted using Prism software and illustrated with P- values. Results There was a statistically significant reduction in HbA1c levels among the individuals in both groups at 12 and 24 months after starting the pathway. Notably, individuals on the pathway displayed lower change in mean HbA1c but a higher statistical significance in their change (P-value 0.006) than the controls (P-value 0.02) with much tighter variation (lesser standard deviation) between patients. Figure 2 shows the change in HbA1c between individuals of each group. No modifiable interventions influencing outcomes can be identified due to the low sample size. However, at the 12-month mark, the use of insulin pumps and CGM had increased compared to baseline in both groups in line with increased access to diabetes technology nationwide. Conclusion Both the control and pathway groups demonstrated improved HbA1c levels at 12 and 24 months compared to their respective baseline values, with controls showing a wider spread of variation. Larger sample sizes are needed for further investigation. In the meantime, the question remains unanswered: 'Does following a high HbA1c pathway truly make a difference?' References Royal College of Paediatrics and Child Health, diabetes quality improvement programme https://www.rcpch.ac.uk/work-we-do/QI-patient-safety/diabetes-quality-programme
Guruviah et al. (Tue,) studied this question.