OBJECTIVES: Prior to use in an international study, the PedsQL™ 3.2 Diabetes Module consisting of 5 reports (Teen report, Adult report, Child report, Parent report for teens, Parent report for children) underwent linguistic validation into 10 languages. A rigorous methodology was conducted to ensure conceptual equivalence, cultural relevance and appropriateness of formulations across the 3 age categories. This involved forward / backward translations and testing on a sample of the 3 age groups. 29 out of 32 items being identical in the original, the aim of our study was to investigate if this was the case in the translations, determine a potential pattern should there be differences and make recommendations on the basis of the results. METHODS: This investigation was carried out as follows: 1) Comparison of the 29 identical items across the Teen, Adult and Child reports in the 10 translations; 2) identification of differences across the three reports; and 3) determination of a pattern in the differences. RESULTS: First results indicate that language versions are relatively similar across the 3 reports with few differences and no identifiable pattern. The differing formulations across age groups are not the same across translations. Differences are not linked to the translation of technical terms, but found in items on general symptoms. CONCLUSIONS: The similarities across the 3 age-specific forms for the 10 languages seem to indicate the universal and intergenerational acceptability of the original concepts and their formulations. Given the differences without identifiable pattern across age categories in some languages however, it is recommended to test the understanding of each item through cognitive debriefing on a sample of each age group despite the use of identical formulations in the original. This will ensure appropriate comprehension across age groups and translations and facilitate international comparison and pooling of data.