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Table 7
Summary of A1C recommendations for nonpregnant people with diabetes*
Recommendation
• Lifestyle, psychosocial, and medical circumstances should be considered when recommending glycemic goals for all age-groups. (E)
Glycemic Control Goals in Pediatrics
As the DCCT only included pediatric patients aged ≥13 years (195 adolescents aged 13–17 years at entry), treatment guidelines for pediatric patients have been based nearly exclusively on professional, expert advice. Furthermore, despite the overall A1C goal of
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Table 7
Summary of A1C recommendations for nonpregnant people with diabetes*
Recommendation
• Lifestyle, psychosocial, and medical circumstances should be considered when recommending glycemic goals for all age-groups. (E)
Glycemic Control Goals in Pediatrics
As the DCCT only included pediatric patients aged ≥13 years (195 adolescents aged 13–17 years at entry), treatment guidelines for pediatric patients have been based nearly exclusively on professional, expert advice. Furthermore, despite the overall A1C goal of
0/5000
View this table:• In this window • In a new windowTable 7Summary of A1C recommendations for nonpregnant people with diabetes*Recommendation• Lifestyle, psychosocial, and medical circumstances should be considered when recommending glycemic goals for all age-groups. (E)Glycemic Control Goals in PediatricsAs the DCCT only included pediatric patients aged ≥13 years (195 adolescents aged 13–17 years at entry), treatment guidelines for pediatric patients have been based nearly exclusively on professional, expert advice. Furthermore, despite the overall A1C goal of <7% for adults with type 1 diabetes, pediatric patients, aged 13–19 years, had an A1C target of <7.5%. This slightly higher A1C target for adolescents with type 1 diabetes was based on expert recommendations and the clinical reality that optimizing glycemic control in adolescent patients with type 1 diabetes is especially challenging, given the physiological and behavioral challenges that confront this age-group.The ADA’s blood glucose and A1C goals traditionally have been developmentally or age based in the pediatric population, but it is now time to alter the traditional goals based on recent data. The traditional recommendations are an A1C goal of <8.5% for youth under the age of 6 years, <8% for those 6–12 years old, and <7.5% for those 13–19 years old. Lower blood glucose levels and lower A1C targets should be pursued as long as patients can avoid severe, recurrent hypoglycemia. Thus, the overall recommendation has included the goal to achieve as close to normal blood glucose and A1C levels as is possible without the occurrence of severe, recurrent hypoglycemia.Historically, the ADA recommended higher A1C targets for young children. This recommendation arose from a combination of two lines of unsubstantiated evidence. First, an older body of literature, reflecting therapy in the premodern era, devoid of insulin analogs, easy-to-use blood glucose monitors, “smart pumps,” and CGM devices, indicated that severe recurrent hypoglycemia with seizure and/or coma in young children was associated with neurocognitive compromise (46). The second line of evidence arose from literature that questioned what, if any, impact blood glucose and A1C levels prior to puberty have on the risk for the development of future long-term complications of diabetes (47,48). With the combination of these two independent lines of reports, it is not surprising that earlier recommendations regarding glycemic targets focused on the avoidance of severe hypoglycemia in order to reduce risk of neurocognitive dysfunction, especially in young children and even school-aged children.
Currently, treatment strategies for children recommend physiological insulin replacement with modern strategies and treatment tools. More recent investigation and active ongoing research have dispelled concerns regarding hypoglycemia and neurocognitive dysfunction (49,50).
Studies assessing neurocognitive function have failed to identify adverse effects of a past history of hypoglycemia in the young child; however, as always, further research needs to be conducted.
There are also questions regarding the premise that the years prior to puberty do not impact the future risk of complications (51). Many investigators and clinicians believe in the importance of controlling blood glucose and A1C levels prior to puberty to reduce risk for both micro- and macrovascular complications. Additionally, there is burgeoning evidence that elevated blood glucose levels and glycemic variability in the very young child with diabetes may produce adverse outcomes in the short term on neurocognitive function and the central nervous system (52,53). These recent articles suggest that hyperglycemia and glycemic variability are associated with changes in the central nervous system white matter, as observed in MRI scans.
Taking into account the combination of spotty past evidence related to the adverse effects of hypoglycemia on the developing brain and increasing evidence from more recent investigations focused on the potential risks of hyperglycemia and glucose variability on the central nervous system, the ADA has decided to alter the recommendations for glycemic targets in pediatric patients with type 1 diabetes and harmonize with other organizations. The International Society for Pediatric and Adolescent Diabetes (ISPAD) uses a single A1C goal of <7.5% across all pediatric age-groups. This recommendation is based on clinical studies and expert opinion, as rigorous evidence does not currently exist. Specifically, the recommendation is derived from a combination of clinical experience and intensive management strategies that provide opportunities to achieve as near-normal glycemic control as possible without the occurrence of severe hypoglycemia.
In light of the above evidence, the ADA will harmonize its glycemic goals with those of ISPAD (as well as the Pediatric Endocrine Society and the International Diabetes Federation) by using a single A1C goal of <7.5% across all pediatric age-groups.
However, as mentioned previously, it must be emphasized that the ADA strongly believes that blood glucose and A1C targets should be individualized with the goal of achieving the best possible control while minimizing the risk of severe hyperglycemia and hypoglycemia and maintaining normal growth and development.
Currently, treatment strategies for children recommend physiological insulin replacement with modern strategies and treatment tools. More recent investigation and active ongoing research have dispelled concerns regarding hypoglycemia and neurocognitive dysfunction (49,50).
Studies assessing neurocognitive function have failed to identify adverse effects of a past history of hypoglycemia in the young child; however, as always, further research needs to be conducted.
There are also questions regarding the premise that the years prior to puberty do not impact the future risk of complications (51). Many investigators and clinicians believe in the importance of controlling blood glucose and A1C levels prior to puberty to reduce risk for both micro- and macrovascular complications. Additionally, there is burgeoning evidence that elevated blood glucose levels and glycemic variability in the very young child with diabetes may produce adverse outcomes in the short term on neurocognitive function and the central nervous system (52,53). These recent articles suggest that hyperglycemia and glycemic variability are associated with changes in the central nervous system white matter, as observed in MRI scans.
Taking into account the combination of spotty past evidence related to the adverse effects of hypoglycemia on the developing brain and increasing evidence from more recent investigations focused on the potential risks of hyperglycemia and glucose variability on the central nervous system, the ADA has decided to alter the recommendations for glycemic targets in pediatric patients with type 1 diabetes and harmonize with other organizations. The International Society for Pediatric and Adolescent Diabetes (ISPAD) uses a single A1C goal of <7.5% across all pediatric age-groups. This recommendation is based on clinical studies and expert opinion, as rigorous evidence does not currently exist. Specifically, the recommendation is derived from a combination of clinical experience and intensive management strategies that provide opportunities to achieve as near-normal glycemic control as possible without the occurrence of severe hypoglycemia.
In light of the above evidence, the ADA will harmonize its glycemic goals with those of ISPAD (as well as the Pediatric Endocrine Society and the International Diabetes Federation) by using a single A1C goal of <7.5% across all pediatric age-groups.
However, as mentioned previously, it must be emphasized that the ADA strongly believes that blood glucose and A1C targets should be individualized with the goal of achieving the best possible control while minimizing the risk of severe hyperglycemia and hypoglycemia and maintaining normal growth and development.
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Table 7
Summary of A1C recommendations for nonpregnant people with diabetes*
Recommendation
• Lifestyle, psychosocial, and medical circumstances should be considered when recommending glycemic goals for all age-groups. (E)
Glycemic Control Goals in Pediatrics
As the DCCT only included pediatric patients aged ≥13 years (195 adolescents aged 13–17 years at entry), treatment guidelines for pediatric patients have been based nearly exclusively on professional, expert advice. Furthermore, despite the overall A1C goal of <7% for adults with type 1 diabetes, pediatric patients, aged 13–19 years, had an A1C target of <7.5%. This slightly higher A1C target for adolescents with type 1 diabetes was based on expert recommendations and the clinical reality that optimizing glycemic control in adolescent patients with type 1 diabetes is especially challenging, given the physiological and behavioral challenges that confront this age-group.
The ADA’s blood glucose and A1C goals traditionally have been developmentally or age based in the pediatric population, but it is now time to alter the traditional goals based on recent data. The traditional recommendations are an A1C goal of <8.5% for youth under the age of 6 years, <8% for those 6–12 years old, and <7.5% for those 13–19 years old. Lower blood glucose levels and lower A1C targets should be pursued as long as patients can avoid severe, recurrent hypoglycemia. Thus, the overall recommendation has included the goal to achieve as close to normal blood glucose and A1C levels as is possible without the occurrence of severe, recurrent hypoglycemia.
Historically, the ADA recommended higher A1C targets for young children. This recommendation arose from a combination of two lines of unsubstantiated evidence. First, an older body of literature, reflecting therapy in the premodern era, devoid of insulin analogs, easy-to-use blood glucose monitors, “smart pumps,” and CGM devices, indicated that severe recurrent hypoglycemia with seizure and/or coma in young children was associated with neurocognitive compromise (46). The second line of evidence arose from literature that questioned what, if any, impact blood glucose and A1C levels prior to puberty have on the risk for the development of future long-term complications of diabetes (47,48). With the combination of these two independent lines of reports, it is not surprising that earlier recommendations regarding glycemic targets focused on the avoidance of severe hypoglycemia in order to reduce risk of neurocognitive dysfunction, especially in young children and even school-aged children.
Currently, treatment strategies for children recommend physiological insulin replacement with modern strategies and treatment tools. More recent investigation and active ongoing research have dispelled concerns regarding hypoglycemia and neurocognitive dysfunction (49,50).
Studies assessing neurocognitive function have failed to identify adverse effects of a past history of hypoglycemia in the young child; however, as always, further research needs to be conducted.
There are also questions regarding the premise that the years prior to puberty do not impact the future risk of complications (51). Many investigators and clinicians believe in the importance of controlling blood glucose and A1C levels prior to puberty to reduce risk for both micro- and macrovascular complications. Additionally, there is burgeoning evidence that elevated blood glucose levels and glycemic variability in the very young child with diabetes may produce adverse outcomes in the short term on neurocognitive function and the central nervous system (52,53). These recent articles suggest that hyperglycemia and glycemic variability are associated with changes in the central nervous system white matter, as observed in MRI scans.
Taking into account the combination of spotty past evidence related to the adverse effects of hypoglycemia on the developing brain and increasing evidence from more recent investigations focused on the potential risks of hyperglycemia and glucose variability on the central nervous system, the ADA has decided to alter the recommendations for glycemic targets in pediatric patients with type 1 diabetes and harmonize with other organizations. The International Society for Pediatric and Adolescent Diabetes (ISPAD) uses a single A1C goal of <7.5% across all pediatric age-groups. This recommendation is based on clinical studies and expert opinion, as rigorous evidence does not currently exist. Specifically, the recommendation is derived from a combination of clinical experience and intensive management strategies that provide opportunities to achieve as near-normal glycemic control as possible without the occurrence of severe hypoglycemia.
In light of the above evidence, the ADA will harmonize its glycemic goals with those of ISPAD (as well as the Pediatric Endocrine Society and the International Diabetes Federation) by using a single A1C goal of <7.5% across all pediatric age-groups.
However, as mentioned previously, it must be emphasized that the ADA strongly believes that blood glucose and A1C targets should be individualized with the goal of achieving the best possible control while minimizing the risk of severe hyperglycemia and hypoglycemia and maintaining normal growth and development.
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• In a new window
Table 7
Summary of A1C recommendations for nonpregnant people with diabetes*
Recommendation
• Lifestyle, psychosocial, and medical circumstances should be considered when recommending glycemic goals for all age-groups. (E)
Glycemic Control Goals in Pediatrics
As the DCCT only included pediatric patients aged ≥13 years (195 adolescents aged 13–17 years at entry), treatment guidelines for pediatric patients have been based nearly exclusively on professional, expert advice. Furthermore, despite the overall A1C goal of <7% for adults with type 1 diabetes, pediatric patients, aged 13–19 years, had an A1C target of <7.5%. This slightly higher A1C target for adolescents with type 1 diabetes was based on expert recommendations and the clinical reality that optimizing glycemic control in adolescent patients with type 1 diabetes is especially challenging, given the physiological and behavioral challenges that confront this age-group.
The ADA’s blood glucose and A1C goals traditionally have been developmentally or age based in the pediatric population, but it is now time to alter the traditional goals based on recent data. The traditional recommendations are an A1C goal of <8.5% for youth under the age of 6 years, <8% for those 6–12 years old, and <7.5% for those 13–19 years old. Lower blood glucose levels and lower A1C targets should be pursued as long as patients can avoid severe, recurrent hypoglycemia. Thus, the overall recommendation has included the goal to achieve as close to normal blood glucose and A1C levels as is possible without the occurrence of severe, recurrent hypoglycemia.
Historically, the ADA recommended higher A1C targets for young children. This recommendation arose from a combination of two lines of unsubstantiated evidence. First, an older body of literature, reflecting therapy in the premodern era, devoid of insulin analogs, easy-to-use blood glucose monitors, “smart pumps,” and CGM devices, indicated that severe recurrent hypoglycemia with seizure and/or coma in young children was associated with neurocognitive compromise (46). The second line of evidence arose from literature that questioned what, if any, impact blood glucose and A1C levels prior to puberty have on the risk for the development of future long-term complications of diabetes (47,48). With the combination of these two independent lines of reports, it is not surprising that earlier recommendations regarding glycemic targets focused on the avoidance of severe hypoglycemia in order to reduce risk of neurocognitive dysfunction, especially in young children and even school-aged children.
Currently, treatment strategies for children recommend physiological insulin replacement with modern strategies and treatment tools. More recent investigation and active ongoing research have dispelled concerns regarding hypoglycemia and neurocognitive dysfunction (49,50).
Studies assessing neurocognitive function have failed to identify adverse effects of a past history of hypoglycemia in the young child; however, as always, further research needs to be conducted.
There are also questions regarding the premise that the years prior to puberty do not impact the future risk of complications (51). Many investigators and clinicians believe in the importance of controlling blood glucose and A1C levels prior to puberty to reduce risk for both micro- and macrovascular complications. Additionally, there is burgeoning evidence that elevated blood glucose levels and glycemic variability in the very young child with diabetes may produce adverse outcomes in the short term on neurocognitive function and the central nervous system (52,53). These recent articles suggest that hyperglycemia and glycemic variability are associated with changes in the central nervous system white matter, as observed in MRI scans.
Taking into account the combination of spotty past evidence related to the adverse effects of hypoglycemia on the developing brain and increasing evidence from more recent investigations focused on the potential risks of hyperglycemia and glucose variability on the central nervous system, the ADA has decided to alter the recommendations for glycemic targets in pediatric patients with type 1 diabetes and harmonize with other organizations. The International Society for Pediatric and Adolescent Diabetes (ISPAD) uses a single A1C goal of <7.5% across all pediatric age-groups. This recommendation is based on clinical studies and expert opinion, as rigorous evidence does not currently exist. Specifically, the recommendation is derived from a combination of clinical experience and intensive management strategies that provide opportunities to achieve as near-normal glycemic control as possible without the occurrence of severe hypoglycemia.
In light of the above evidence, the ADA will harmonize its glycemic goals with those of ISPAD (as well as the Pediatric Endocrine Society and the International Diabetes Federation) by using a single A1C goal of <7.5% across all pediatric age-groups.
However, as mentioned previously, it must be emphasized that the ADA strongly believes that blood glucose and A1C targets should be individualized with the goal of achieving the best possible control while minimizing the risk of severe hyperglycemia and hypoglycemia and maintaining normal growth and development.
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7 ตารางสรุปข้อแนะนำสำหรับคนที่เป็นเบาหวาน nonpregnant A1c แนะนำ
- วิถีชีวิต จิตสังคม และสถานการณ์ทางการแพทย์ที่ควรพิจารณาเมื่อเลือกเป้าหมายระดับน้ำตาลสำหรับทุกกลุ่มอายุ ( E )
เป้าหมายในการควบคุมระดับน้ำตาลในกุมารเวชศาสตร์เป็น dcct รวมเฉพาะผู้ป่วยเด็กอายุ 13 ปี ( 195 ≥วัยรุ่นอายุ 13 - 17 ปี ในรายการ แนวทางการรักษาผู้ป่วยเด็กที่ได้รับการใช้เกือบเฉพาะมืออาชีพให้คำแนะนำของผู้เชี่ยวชาญ นอกจากนี้ แม้โดยรวม A1C เป้าหมาย < 7% สำหรับผู้ใหญ่ที่มีโรคเบาหวานชนิดที่ 1 ผู้ป่วยเด็กอายุ 13 - 19 ปี มีเป้าหมาย A1c ของ < 7.5 %นี้สูงกว่าเล็กน้อย A1C เป้าหมายสำหรับเด็กวัยรุ่นโรคเบาหวานชนิดที่ 1 โดยผู้เชี่ยวชาญแนะนำและความเป็นจริงทางคลินิกที่เหมาะสมการควบคุมระดับน้ำตาลในผู้ป่วยโรคเบาหวานชนิดที่ 1 โดยเฉพาะวัยรุ่นที่ได้รับทางสรีรวิทยาและพฤติกรรมความท้าทายที่เผชิญหน้ากลุ่มนี้
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7 ตารางสรุปข้อแนะนำสำหรับคนที่เป็นเบาหวาน nonpregnant A1c แนะนำ
- วิถีชีวิต จิตสังคม และสถานการณ์ทางการแพทย์ที่ควรพิจารณาเมื่อเลือกเป้าหมายระดับน้ำตาลสำหรับทุกกลุ่มอายุ ( E )
เป้าหมายในการควบคุมระดับน้ำตาลในกุมารเวชศาสตร์เป็น dcct รวมเฉพาะผู้ป่วยเด็กอายุ 13 ปี ( 195 ≥วัยรุ่นอายุ 13 - 17 ปี ในรายการ แนวทางการรักษาผู้ป่วยเด็กที่ได้รับการใช้เกือบเฉพาะมืออาชีพให้คำแนะนำของผู้เชี่ยวชาญ นอกจากนี้ แม้โดยรวม A1C เป้าหมาย < 7% สำหรับผู้ใหญ่ที่มีโรคเบาหวานชนิดที่ 1 ผู้ป่วยเด็กอายุ 13 - 19 ปี มีเป้าหมาย A1c ของ < 7.5 %นี้สูงกว่าเล็กน้อย A1C เป้าหมายสำหรับเด็กวัยรุ่นโรคเบาหวานชนิดที่ 1 โดยผู้เชี่ยวชาญแนะนำและความเป็นจริงทางคลินิกที่เหมาะสมการควบคุมระดับน้ำตาลในผู้ป่วยโรคเบาหวานชนิดที่ 1 โดยเฉพาะวัยรุ่นที่ได้รับทางสรีรวิทยาและพฤติกรรมความท้าทายที่เผชิญหน้ากลุ่มนี้
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