New hemoglobin A1c targets have been established for patients of all ages with type 1 diabetes, according to a position statement published online in Diabetes Care. The position statement was published to coincide with the annual meeting of the American Diabetes Association, held from June 13 to 17 in San Francisco.
The etiology and pathophysiology of type 1 and type 2 diabetes are distinct and should be considered separately. With this in mind, Jane L. Chiang, MD, from the American Diabetes Association in Alexandria, Va., and colleagues summarized data specific to the comprehensive care of patients with type 1 diabetes.
According to the guidelines, glycemic targets should be individualized with the aim of achieving the best possible control while minimizing the risk of severe hyper- and hypoglycemia. Based on clinical studies and expert opinion, the recommended hemoglobin A1c target should be less than 7.5% for all pediatric age groups (aged younger than 18 years). This target, which is lower than the traditional recommendations, should be pursued as long as patients can avoid severe, recurrent hypoglycemia. For non-pregnant adults, the recommended glycemic target is less than 7.0 percent, which reduces the microvascular complications of diabetes. For older adults, the targets vary from less than 7.5 to less than 8.5 percent based on comorbidities.
The statement also addresses the diagnosis of diabetes; initial evaluation and follow-up; assessment and treatment of psychosocial issues; monitoring of blood glucose and glycated hemoglobin; treatment options; and specific settings and populations.