Glycemic control in type 1 diabetes mellitus among Bulgarian children and adolescents: the results from the first and the second national examination of HbA1c

The standardized hemoglobin A(1c) (HbA(1c)) test is an essential tool to evaluate the glycaemic control and the diabetes care. The aim of our study was to evaluate and compare the actual HbA(1c) level in a cohort of Bulgarian patients with type 1 diabetes aged 0-19 years in two consecutive national studies, in 2012 and 2014. We used a standardized method for HbA(1c) high performance liquid chromatography (HPLC). The survey was conducted in 11 paediatric endocrinology practices in Bulgaria. Overall 829 patients with type 1 diabetes participated in the first study, 422 boys and 407 girls, aged 11.9 +/- 4.2 years. The second study included 498 patients: 261 boys and 237 girls, aged 11.6 +/- 4.1 years. The mean HbA(1c) level for the patients studied in 2014 (8.42 +/- 1.69%) was significantly lower compared to that in the patients studied in 2012 (8.93 +/- 1.98%, p < 0.001). Significantly more patients in the second study (36%) showed optimal control with HbA(1c) < 7.5% (p < 0.05) compared to those from the first one (24.9%). Teenagers in both studies had higher HbA(1c) levels compared to the other age groups: 9.19 +/- 2.11% in 2012 and 8.8 +/- 1.87% in 2014. We found significant differences in the HbA(1c) levels between the different centres in Bulgaria (from 7.92% to 9.95% in 2012 and from 7.42% to 9.13% in 2014). All age groups, except the teenagers showed improvement in the glycemic control in the second study as a result of continuous and structured education of the patients and their families.