Supplementary Material for: Vascular complications in children and young people with type 1 diabetes: a worldwide assessment of diabetologists’ adherence to international recommendations

Introduction: This global survey evaluated the practices and adherence to international Clinical Practice Consensus Guidelines (CPCG) of physicians involved in pediatric diabetes care regarding screening, prevention and treatment of vascular complications of type 1 diabetes (T1D).
Method: A web-based survey gathering data about respondents’ background, practices related to screening, prevention, and treatment of diabetic nephropathy, retinopathy, neuropathy and macrovascular diseases and a self-assessment of physicians’ knowledge based on the ISPAD CPCG 2018 was shared by ISPAD.
Results: We received 175 responses from 62 countries (60% female, median age 42.3 years, 72.0% ISPAD members). Two-thirds of respondents initiated nephropathy and retinopathy screening per CPCG recommendations. Only half of them adhered to recommendations for neuropathy and macrovascular disease risk factors (RFs). Over 85% of respondents used the recommended screening method for nephropathy, retinopathy and macrovascular disease RFs, and only 59% for neuropathy. Lack of access to neuropathy and macrovascular diseases RF screening methods was reported by 22.2% and 11.8% of respondents, respectively. Adherence to recommended screening frequency varied: 92% for nephropathy, around two-thirds for neuropathy and macrovascular disease RFs, and only 17.7% for retinopathy. Most participants aligned their practices for treating T1D complications with CPCG recommendations, except for nephropathy. Significant differences in adherence to CPCG and individuals’ financial contributions reflected countries' income levels. Around 50% of the respondents were very familiar with the ISPAD CPCG content.
Conclusion: Our study highlights global variation in adherence to CPCG for T1D vascular complications, which is influenced by country income and healthcare disparities. It also revealed knowledge gaps among physicians on this critical topic.

引言：本项全球性调查评估了参与儿童糖尿病诊疗的医师，在1型糖尿病（type 1 diabetes, T1D）血管并发症的筛查、预防与治疗方面的临床实践，及其对国际临床实践共识指南（Clinical Practice Consensus Guidelines, CPCG）的依从情况。

方法：由国际儿科糖尿病学会（International Society for Pediatric and Adolescent Diabetes, ISPAD）发起一项网络调查，收集受访者的背景信息、与糖尿病肾病（diabetic nephropathy）、糖尿病视网膜病变（retinopathy）、糖尿病神经病变（neuropathy）及大血管疾病相关的筛查、预防与治疗实践数据，并基于2018年ISPAD发布的CPCG开展医师知识自评。

结果：本研究共回收来自62个国家的175份有效问卷，受访者中女性占比60%，年龄中位数为42.3岁，72.0%为ISPAD会员。三分之二的受访者按照CPCG建议启动了糖尿病肾病与糖尿病视网膜病变的筛查。仅半数受访者遵循了糖尿病神经病变及大血管疾病危险因素（risk factors, RFs）的相关诊疗建议。超85%的受访者采用了针对糖尿病肾病、糖尿病视网膜病变及大血管疾病危险因素的推荐筛查方法，而针对糖尿病神经病变的这一比例仅为59%。分别有22.2%和11.8%的受访者表示无法获取糖尿病神经病变与大血管疾病的筛查方法。对推荐筛查频率的依从性差异显著：糖尿病肾病的依从率为92%，糖尿病神经病变与大血管疾病危险因素的依从率约为三分之二，而糖尿病视网膜病变的依从率仅为17.7%。绝大多数受试者的1型糖尿病并发症诊疗实践均符合CPCG建议，仅糖尿病肾病领域例外。医师对CPCG的依从程度与个人经济负担水平均存在显著差异，且该差异与所在国家的收入层级密切相关。约50%的受访者对2018年ISPAD发布的CPCG内容十分熟悉。

结论：本研究揭示了全球范围内医师对1型糖尿病血管并发症相关CPCG的依从性存在差异，且该差异受国家收入水平与医疗资源分配不均的影响。同时，本研究也发现，在此关键领域内，部分医师仍存在知识盲区。