New HbA1c recommendation for diabetic children

In a new position statement, the American Diabetes Association (ADA) has recommended a lower hemoglobin A_1c (HbA_1c) target for children with type 1 diabetes and made the target uniform across all pediatric age groups.

The new HbA_1c target is lower than 7.5% for all children and adolescents aged younger than 19 years. Previous guidelines called for HbA_1c goals below 8.5% for children aged younger than 6 years; below 8% for children aged 6 to 12 years; and below 7.5% for youths aged 13 to 19 years.

The recommendation aims to achieve HbA_1c levels as close to normal as possible without inducing severe, recurrent hypoglycemia. It arises from the recognition that new ways of treating diabetes have reduced the risk of severe hypoglycemia and from recent data indicating increased risk to the central nervous system, especially the white matter, from hyperglycemia and variable blood glucose levels.

The position statement emphasizes, however, that treatment goals must be individualized based on variables such as the child’s age, duration of diabetes, comorbid conditions, and specific patient considerations.

The new HbA_1c goal brings the ADA recommendation into line with the pediatric HbA_1c target advocated by the International Society for Pediatric and Adolescent Diabetes, the International Diabetes Federation, and the Pediatric Endocrine Society.

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