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New Target Recommended for Type 1 Diabetes Treatment

July 9, 2014

New Target Recommended for Type 1 Diabetes Treatment

  1. Cornelius W. Van Niel, MD

The American Diabetes Association has set the hemoglobin A1C goal at <7.5% for children of all ages.

  1. Cornelius W. Van Niel, MD

In 1993, the Diabetes Control and Complications Trial showed that for patients with type 1 diabetes, a hemoglobin A1C target <7.0% was necessary to help prevent microvascular complications; however, the only children in this study were teenagers. Because of concern about the neurocognitive effects of episodic hypoglycemia in younger children, as well as the practicalities of managing type 1 diabetes in adolescents, A1C targets for children were relaxed to <8.5% (age range, 0–6 years), <8% (age range, 6–12 years), and <7.5% (age range, 13–19 years).

Now, given evidence that retinopathy, nephropathy, and neuropathy can begin as early as 5 years into a child's illness and that variable glucose control and hyperglycemia can also have effects on the central nervous system, the American Diabetes Association (ADA) has released a new recommendation (based on expert opinion) that all children with type 1 diabetes strive for an A1C of <7.5%. Advances in management (e.g., modern glucose sensors and insulin pumps) have enabled tighter glucose control in children with less risk for hypoglycemic episodes. Experts emphasize that A1C targets must always be individualized based on considerations such as illness duration, comorbidities, presence of severe recurrent hypoglycemic episodes, and psychosocial circumstances.

Comment

This new ADA treatment goal of hemoglobin A1C <7.5% matches that of the International Society for Pediatric and Adolescent Diabetes. Better glucose control in prepubertal children is important for preventing microvascular complications, and new technologies are making this possible with a better margin of safety.

  • Disclosures for Cornelius W. Van Niel, MD at time of publication Equity Covidien; Express Scripts; Johnson & Johnson; Merck

Citation(s):

Reader Comments (3)

Richard K Bernstein, MD, FACE, FACN , FCCWS Physician, Endocrinology, Medicaal Office

When children are given very low Carbohydrate diets and physiologic , instead of industrial doses of insulin, the risk of severe hypoglycemia vanishes. The adverse effects of elevated blood sugar upon brain development have been well documented in ADA publications. HgbA1c of 7.5% corresponds to an average BG of 200mg/dl. Non diabetic children have BGs in the 70s. Forcing kids to have an A1c of 7.5% is criminal.

Pablo Hernandez Alvarez Physician, Critical Care Medicine, Cuba

targenting hemoglobin A1c less tan 7.5 % is challenging but it could decrease the incidence of diabetic nephropathy and the need of RRT in children, sometimes difficult to accept and perform

Bernardo Elizondo. Physician, Pediatric Subspecialty, Children´s Sonora State Hospital, Mexico.

It is very important to be up to date with the statements recomendations by experts in this field.

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