New From ADA: A Single Hemoglobin A1c Target for All Children

SAN FRANCISCO—The American Diabetes Association (ADA) released an updated position statement on hemoglobin A1c (HbA1c) target levels for children with type 1 diabetes. The announcement came at the ADA's annual scientific sessions on Monday, June 16 and was published online simultaneously in Diabetes Care.

The new HbA1c target level is now below 7.5% for all children younger than 19 years of age who have received a diagnosis of type 1 diabetes. The new single pediatric target replaces the previous 3-tiered target levels of below 8.5% for children younger than 6, below 8.0% for children from 6 to 12, and below 7.5% for children from 13 to 19. The adult HbA1c target remains at below 7.0%.

Jane L. Chiang, MD, lead author of the position statement, said that health care providers had been targeting HbA1c levels below 7.5% goal for children for years, and that other expert organizations already had recommended an HbA1c goal of less than 7.5%.

"These pediatric targets are going to have a very important impact moving forward," said Chiang, who also is the ADA's senior vice president of medical and community affairs. "We really wanted to make sure that people are aware that simple, comprehensive, consistent messaging is delivered not only to the endocrine community, but also to our primary care colleagues."

The previous targets had been based on older data and clinical experience about severe hypoglycemia. Position statement coauthor Lori M. B. Laffel, MD, said that more recent research has shown that hypoglycemia rates are not higher in the youngest patients and at lower HbA1c levels. She explained that this indicates the potential for acute adverse hyperglycemia-related effects on the youngest patients' central nervous system. This new medical information led to the updated HbA1c target.

"We realized that with this position statement, we had the opportunity to reexamine the reasons we had separate glycemic targets for different age categories of youth within the pediatric population," Laffel said. "It seemed timely for us to reexamine the age-specific HbA1c targets … and to look across different societies and countries and guidelines with respect to pediatric care and glycemic target recommendations."

One-half to two-thirds of new cases of type 1 diabetes each year are diagnosed in patients younger than 18. The position statement's authors emphasized that the targets are suggestions based on evidence but are not strict requirements. 

—Tim Casey