GLYCATED HEMOGLOBIN CENTILES - A BASIS FOR AUDIT IN CHILDRENS CLINICS

Services for children with diabetes are a good model for audit because of relatively well-defined and available measures of outcome. Estimat ion of glycated haemoglobin (HbA1) is accepted as one index of control , although the assay and normal ranges vary in different centres. Shef field has a stable clinic population and we have taken blood for HbA1 on each patient two to four times per year since 1983. HbA1 values hav e been aligned in 3-monthly increments from time of diagnosis to const ruct a graph showing the mean plus or minus two standard deviation val ues for the clinic population and also a rough 'centile chart' that de scribes the unfortunate but expected pattern of deteriorating control with duration of diabetes. There are undoubtedly methodological flaws in this novel approach; however, such charts constructed for each clin ic may be a suitable basis for comparative assessment of the control o f an individual and also for auditing the effects of changes in practi ce that strive for optimum glucose levels in the clinic population.