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ADA: New HbA1c Target of 7.5% for Type 1 Children and Older Adults

Recent scientific evidence and better tools to monitor for hypoglycemia helped establish the new position statement….

Anne Peters, MD, FACP, professor at the Keck School of Medicine, University of Southern California, said during a press conference at the American Diabetes Association’s 74th Scientific Sessions, “Our goal here is to present a position statement that looks specifically at the needs of people with type 1 diabetes across the age spectrum.” “We now know that we have many, many people who are older with type 1 diabetes … who are frankly living long enough to now be dealing with the same issues that our elderly population faces. So we want this to really address those needs across the lifespan and address both the pediatric population as well as this much larger, older population.”

Peters and her co-authors described the new guidelines as filling a need in the medical community as type 1 diabetes is often grouped with type 2 diabetes in adults or considered only a pediatric disease where a fear of hypoglycemia previously mandated staged glycemic targets.

According to a new position statement released at the Association’s 74th Scientific Sessions, the American Diabetes Association is lowering its target recommendation for blood glucose levels for children with type 1 diabetes, to reflect the most current scientific evidence and additionally to harmonize its guidelines with those of the International Society for Pediatric and Adolescent Diabetes (ISPAD).

The Association now recommends that children under the age of 19 diagnosed with type 1 diabetes strive to maintain an A1C level lower than 7.5 percent. Previously, target blood glucose levels – as measured by the A1C, a test that reflects average blood glucose levels over several months – could be as high as 8.5 percent for children under 6 years of age, 8.0 percent for children 6-12 years of age and 7.5 for adolescents under the Association’s guidelines. These targets were set because of concerns over complications caused by low blood glucose, or hypoglycemia.

However, research now shows that prolonged hyperglycemia can lead to the early development of serious complications in children, such as cardiovascular disease and kidney disease. These complications were once believed to occur only in adults.

“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 percent over time. This is not to say we are no longer concerned about hypoglycemia, but we now have better tools to monitor for hypoglycemia,” said Jane Chiang, MD, Senior Vice President, Medical and Community Affairs, American Diabetes Association and one of the lead authors on the Association’s Position Statement. “The 7.5 percent target is evidence-based; however, we want to emphasize that blood glucose and A1C targets must be individualized to safely achieve the best outcomes.”

Jane Chiang, MD, senior vice president of medical and community affairs for the American Diabetes Association, said the association debated whether these guidelines were a change that should be made since practitioners were comfortable with the previous levels.

“We felt it was very important to harmonize with other organizations nationally and internationally to make sure we have simple and consistent messages for glycemic targets for those with type 1 diabetes,” she said. “We want all of you to know that the American Diabetes Association is very committed to patients with type 1 diabetes. … We really want to separate out the two different types of diabetes.”

Practice Pearls:
  • A position statement of the ADA summarizes available data specific to the comprehensive care of individuals with type 1 diabetes.
  • Note that recommended A1c targets are higher for those under 18 years and healthy older adults than adults.
  • Chiang reiterated that these are merely guidelines and physicians must continue to take their individual patients’ needs into consideration.

Presented at: American Diabetes Association’s 74th Scientific Sessions; June 16, 2014; San Francisco.