ADA Reevaluates Glycemic Goals for Type 1 Diabetes

The American Diabetes Association (ADA) announced at its annual Scientific Sessions on Monday an updated position statement regarding hemoglobin A1c (HbA1c) target levels for children with type 1 diabetes.
 
For all children under 19 years of age diagnosed with type 1 diabetes, the new target HbA1c level is <7.5%. The position statement was simultaneously published online in Diabetes Care.
 
Previously, the ADA’s recommended HbA1c level target was <8.5% for children younger than 6 years of age, <8.0% for children from 6 to 12 years of age, and <7.5% for children from 13 to 19 years of age. The adult targets remain at <7.0%.
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Jane Chiang, MD, the ADA’s senior vice president of medical and community affairs and a lead author of the position statement, said providers have followed the <7.5% HbA1c goal for children for the past few years. Other organizations had already set the target at <7.5%.
 
“These pediatric targets are going to have a very important impact moving forward,” Dr. Chiang said. “We really wanted to make sure that people are aware that simple, comprehensive, consistent messaging is delivered not only to the endocrine community, but to our primary care colleagues, aswell.”
 
The old targets were based on experience with severe hypoglycemia from previous eras. Lori Laffel, MD, who worked on the position statement, said that new information allowed the doctors to re-examine rates of hypoglycemia. They found rates of hypoglycemia were not higher in the youngest patients and at lower HbA1c levels. Dr. Laffel said that research indicatesthere is a potential for an acute adverse effects on the central nervous system of hyperglycemia on the youngest patients.
 
“We realized with this position statement, we had the opportunity to re-examine the reasons we had separate glycemic targets for different age categories of youth within the pediatric population,” Dr. Laffel said. “It seemed timely for us to re-examine the age-specific, (HbA1c) targets that the ADA had promulgated for a number of years [and] to look across different societies and countries and guidelines with respect to pediatric care and glycemic target recommendations.”
 
Although type 1 diabetes is considered as mostly affecting children, an estimated 1 to 2 million adults have the disease, according to Anne Peters, MD, an author of the position statement. Of the new cases of type 1 diabetes each year, one-third to one-half are diagnosed in patients older than 18 years of age. All of the authors emphasized the targets are suggestions based on evidence, but they are not strict requirements.
 
“We always would recommend individualizing targets for the person’s needs, the person’s duration of disease, the person’s age, the person’s comorbidities - - whatever is necessary for that individual,” Dr. Laffel said. “However, we’re so pleased to be able to have offered a unified target for the pediatric population and even more pleased to have a single set of guidelines that will cross the entire life span for all patients with type 1 diabetes.”
 
—Tim Casey