ADA Type 1 Diabetes Position Statement Changes A1C Recommendations for Pediatric Patients
BOSTON – (July 18, 2014) – The American Diabetes Association released a position statement outlining care protocols for persons with type 1 diabetes. The guidelines were officially released at the 2014 ADA Annual Conference in San Francisco this past June. The position statement covers care recommendations for all age ranges, from early childhood to adulthood and into the geriatric years.
Lori Laffel, M.D., M.P.H., Chief of the Pediatric, Adolescent and Young Adult Programs and Senior Investigator in the Section on Genetics and Epidemiology at Joslin.
This position statement arose from the type 1 Diabetes Sourcebook which was produced by the American Diabetes Association and the JDRF, and received funding from the Helmsley Charitable Trust. Over half a dozen authors from the Joslin Diabetes Center contributed to the Sourcebook and the position statement.
Lori Laffel, M.D., M.P.H., Chief of the Pediatric, Adolescent and Young Adult Programs and Senior Investigator in the Section on Genetics and Epidemiology, was a lead author on guidelines. The new position statement is exclusively focused on those with type 1 diabetes rather than providing care recommendations for people with diabetes in general.
“Previously, guidelines for the care of persons with diabetes didn’t necessarily distinguish between patients with type 1 and type 2 diabetes,” says Dr. Laffel. She says that the statement’s streamlined presentation should make for an easier read for busy care providers. “Often the guidelines that come out every January from the Diabetes Association are very long. They compile an entire journal,” says Dr. Laffel. “This particular guideline can be digested in a brief reading.”
One of the biggest changes in care recommendations relates to A1C levels in children although many other areas are covered in the new position statement. “There is a focus on glycemic control, but the statement also provides guidance on reducing risk for both short and long term complications of type 1 diabetes,” says Dr. Laffel.
The ADA now supports an A1C target of less than 7.5 percent across the entire pediatric age range, from infancy until the age of 18. Previously, A1C targets were broken down into specific age ranges. For example, under the age of six, the target A1C was less than 8.5 percent, between the ages of 6 and 12 the target was less than 8 percent, and for patients ages 13 to 19 the target A1C range was less than 7.5 percent. These age-specific A1C targets were based upon a previous era in which there were many concerns for hypoglycemia among very young pediatric patients. Now, with the availability of high tech glucose monitoring and insulin delivery strategies, there are many opportunities for improved glycemic control without severe hypoglycemia across the entire age range of the pediatric population.
Many health care professionals, especially those at the Joslin Diabetes Center, have been advocating intensive diabetes management for many years. “The new pediatric target of less than 7.5 percent is now harmonized with many national and international diabetes associations which recommend an A1C target of less than 7.5 percent,” says Dr. Laffel. “We’re excited that the ADA recommendations provide a unified approach to the management of type 1 diabetes.”