ADA Tightens A1C Goals for Children

Scientists from the American Diabetes Association (ADA) held an open Twitter chat to discuss new guidelines for children with Type 1 diabetes, as part of the rollout of the association’s first Type 1-only position paper. Endocrinologists Dr. Jane Chiang and Dr. Sue Kirkman fielded questions for the ADA.

In a move that stirred up online chatter, the ADA tightened its A1C goals for children. Previously, ADA guidelines called for A1C goals of 8.5 or lower for children under 6 years old, 8.0 or lower for children ages 6 to 12, and then 7.5 or lower for teens. The new guidelines now call for an A1C score of 7.5 or lower for all children, regardless of age.

The recently-released position paper is the first from the ADA to discuss Type 1 diabetes exclusively. In the past, Type 1 and Type 2 guidelines were lumped together. Issuing Type 1-only position papers will help physicians focus on the unique characteristics and treatment options for Type 1, Dr. Chiang said.

“Diabetes is not a one-size-fits-all disease, and it’s important that we recognize that,” Dr. Chiang said

A1C goals for children were tightened because new research shows that children with high blood glucose levels before puberty are at greater risk for heart and kidney problems later on in life, according to Dr. Chiang. A1C guidelines always must balance the long-term health impact of high blood glucose levels with the short-term danger of hypoglycemia. In the past, an A1C goal of 7.5 or lower for children seemed too difficult to reach without risking increased hypoglycemia. Dr. Kirkman believes that pumps and other advances in diabetes home care technology will now make such a goal more attainable without dire risk of hypoglycemia.

“There will always be concerns about hypoglycemia, but the good news is we now have better tools to prevent it,” Dr. Kirkman said.

Not everyone involved with the chat was convinced, however. Rachel Heard, a certified diabetes educator, said that families of children with diabetes often struggle to meet recommended A1C goals, and they need more resources if they are going to meet the new one.

“People with T1D need more support than what is currently available,” Heard said.

Both Dr. Chiang and Dr. Kirkman agreed that more support is needed. The ADA has called upon insurance companies to understand that frequent testing is a necessity, not a choice, for many with Type 1 diabetes, and the costs for supplies must be fully reimbursed. The two doctors also suggest it’s important that more people in the diabetes community offer each other peer support, and advocate for those with Type 1.

In October 2014, the ADA is scheduled to come out with its first-ever guidelines concerning how to care for children with Type 1 diabetes in a daycare setting.

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Craig Idlebrook is a past editor for Insulin Nation, Type 2 Nation, and Información Sobre Diabetes. He is now the community engagement and content manager for T1D Exchange.

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