The American Diabetes Association (ADA) has released a new position statement that lowers target hemoglobin A1c levels for children with type 1 diabetes.
The association’s target blood glucose levels had previously been set at 8.5% for children age 6 and younger, 8% for those 6 to 12 years, and 7.5% for adolescents. The ADA’s new recommendation is that all children with type 1 diabetes younger than age 19 should keep their A1c levels lower than 7.5%.
The ADA revised its threshold based on current findings that children with high blood glucose levels (prolonged hyperglycemia) could potentially develop serious complications usually seen in adults, such as kidney or cardiovascular disease.
“Many investigators and clinicians believe in the importance of controlling blood glucose and A1c levels prior to puberty to reduce risk for both micro- and macrovascular complications,” according to the ADA statement. Evidence also exists that high blood glucose levels and glycemic variability in young diabetic children could have a short-term negative effect on the central nervous system and on neurocognitive function, the statement said.
“The evidence shows that there is a greater risk of harm from prolonged hyperglycemia that would occur if children maintained an A1c of 8.5% over time. This is not to say we are no longer concerned about hypoglycemia, but we now have better tools to monitor” for low blood sugar, said Jane Chiang, MD, a lead author on the position statement and ADA’s senior vice president for medical and community affairs, in a statement issued by ADA.
“The 7.5% target is evidence-based; however, we want to emphasize that blood glucose and A1C targets must be individualized to safely achieve the best outcomes,” added Chiang.
The ADA said its revision conforms to guidelines set by the International Society for Pediatric and Adolescent Diabetes (ISPAD) and reflects currently available scientific evidence. According to the ADA position paper, ISPAD uses the <7.5% target for all pediatric age groups.
The position statement also makes it clear that type 1 and 2 diabetes are different diseases—and that recognizing these differences could help to prevent associated complications.