Targeted levels are made lower, but young patients need individualized care, ADA guideline says
By Robert Preidt
MONDAY, June 16, 2014 (HealthDay News) -- Experts at the American Diabetes Association are advising a lower blood sugar target for children and teens with type 1 diabetes.
According to the ADA, patients younger than age 19 should try to maintain an A1C blood sugar level lower than 7.5 percent, the group said in a new position statement.
A1C is a test that determines average blood sugar (glucose) levels over several months.
"The new targets should help redouble efforts at improving glucose control in the patient group that is currently most challenging -- adolescents," said Dr. Robert Rapaport, director of the division of pediatric endocrinology and diabetes at Kravis Children's Hospital at Mount Sinai, New York City. He was not involved in drawing up the new guidelines.
In type 1 diabetes, the body can't produce enough insulin to convert food into energy, and people with type 1 diabetes must take insulin to survive.
Previously recommended A1C levels could be as high as 8.5 percent for children younger than 6 years, 8 percent for those ages 6 to 12, and 7.5 percent for those ages 13 to 19. These higher targets were set due to concerns about complications caused by a sometimes dangerous condition known as low blood sugar, or hypoglycemia.
However, recent research shows that prolonged high blood sugar levels -- hyperglycemia -- can lead to the development of serious complications in children, including heart and kidney disease. Previously, it had been thought that these complications occurred only in adults.
The targets for blood sugar control have therefore been ratcheted a bit downwards, the ADA explained.
The new blood sugar target for youngsters with type 1 diabetes, which was released at the ADA's annual meeting in San Francisco on Monday, matches the guidelines of the International Society for Pediatric and Adolescent Diabetes.
"The evidence shows that there is a greater risk of harm from prolonged hyperglycemia that would occur if children maintained an A1C of 8.5 percent over time," statement co-lead author Dr. Jane Chiang, the ADA's senior vice president for medical and community affairs, said in an association news release.
"This is not to say we are no longer concerned about hypoglycemia, but we now have better tools to monitor for hypoglycemia," she added.
While the new 7.5 percent target is based on evidence from respected studies, "we want to emphasize that blood glucose and A1C targets must be individualized to safely achieve the best outcomes," Chiang added.
Experts agreed with that stance.
"Considering the risk of hypoglycemia in the young children, the management should be personalized," said Dr. Siham Accacha, director of the pediatric diabetes program at Winthrop-University Hospital in Mineola, N.Y. "More than any other condition, treating children with diabetes requires special consideration," he said.
He and Rapaport agreed that the advent of better medications and medical technologies mean that hypoglycemia is somewhat less of a risk than it was in the past. Those advances include sophisticated insulin pumps and "glucose sensors that have the ability to more quickly recognize high, as well as low, glucose levels," Rapaport explained.
Coupled with educating young patients about the risks of hypoglycemia, these advances "may help diminish the incidence of severe hypoglycemia and, at the same time, allow children and adolescents to reach their target goal with less difficulty," Accacha said.
"Type 1 diabetes requires intensive insulin management that differs from how type 2 is managed," statement co-author Dr. Anne Peters, a professor at Keck Medicine at the University of Southern California, said in the ADA news release.
"People with type 1 require more supplies and must monitor their blood glucose levels more often. This is not a one-size-fits-all disease, and it's important that we recognize that," she added.
There's more on type 1 diabetes at the Juvenile Diabetes Research Foundation.
SOURCES: Siham Accacha, M.D., director, pediatric diabetes program, Winthrop-University Hospital, Mineola, N.Y.; Robert Rapaport, M.D., director, division of pediatric endocrinology and diabetes, Kravis Children's Hospital at Mount Sinai, New York City; American Diabetes Association, news release, June 16, 2014
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