Type 1 Diabetes Youths’ High HbA1c Goals Unmet
Most children with type 1 diabetes have hemoglobin A1c (HbA1c) values above target levels, according to a published study.
Jamie R. Wood, M.D., from the Children’s Hospital Los Angeles, and colleagues assessed the proportion of youths meeting targets for HbA1c, blood pressure, and body mass index (BMI) using data from 13,316 participants in the T1D Exchange Clinic Registry younger than 20 years old with type 1 diabetes for at least one year.
Already Too High Targets Unmet
The researchers found that 64, 43, and 21 percent of participants met the American Diabetes Association HbA1c targets of less than 8.5 percent for those younger than 6 years, less than 8.0 percent for those age 6 to younger than 13 years old, and less than 7.5 percent for those age 13 to younger than 20 years old, respectively.
Most participants met the blood pressure and lipid targets, and two-thirds met the goal of less than 85th percentile for BMI.
“Despite advances in technologies and strategies for care, achieving HbA1c targets remains a significant challenge for the majority of youth in the T1D Exchange registry. Moreover, a large number of youth with diabetes already have additional vascular disease risk factors at a young age,” the authors write. “This analysis suggests further transformations to improve pediatric diabetes care are needed to prevent future complications of diabetes.”
These target A1c ranges are way too high, in our opinion. To have the majority of young people with type 1 diabetes fall outside of ranges that are already too high to begin with is alarming. Since microvascular damage has been shown to begin at 5.6 we think the target should be below that threshold. However, we recognize that the “eat whatever you want and cover it with insulin” advice typically given will not allow most people to achieve healhy A1c ranges.
We agree wholeheartedly with the authors when they say, “further transformations to improve pediatric diabetes care are needed to prevent future complications of diabetes.” We believe the Health-e-Solutions lifestyle can provide the transformational foundation for optimal blood sugar control and better long term living.
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Diabetes Care, Jan. 22, 2013