Tuesday, June 17, 2014

New A1C targets for children with diabetes.

I was privileged to attend the 74th annual ADA Scientific Session in San Francisco this last week.  I have a whirlwind of information to get out to you, so much so, I’m honestly overwhelmed.  I hope I’m up to the task.

As I try to get my mental ducks in a row, I decided I needed to address the biggest duck of all: New ADA guidelines on acceptable A1C targets in children.

It affects us all, and as I’m sure you all do, I have mixed feelings on the subject.

For those who haven’t heard the details, a position statement by the ADA was released yesterday indicating a new A1C target in pediatric patients, specifically for those with Type 1 Diabetes.  Previous goals were less than 8.5% for children under 6 years old, 8% for those between 6 and 12 years old, and 7.5% for those 13 to 18 years old.

A new recommended target of 7.5% has been set for all age ranges now.  Across the board. Which not surprisingly now aligns with targets set internationally.

I heard this one day after I attended a session that indicated that more than 70% of patients don’t reach A1C targets.  And that study was with the old goals.

If we aren’t reaching the old targets, why are we making them more difficult to attain?

I guess the short answer is, because now we know better.

The old guidelines were drafted years ago, before insulin analogs and before insulin pumps and CGM’s.  Also before new studies that indicate children are in fact at higher risk of complications with higher A1C’s.

Back in the day they worried that lower A1C targets would contribute to severe Hypoglycemia.  Back then, and even now…we all know constant lows are dangerous and need to be avoided. Now, with the tools we have…that just isn’t the case anymore.

Along with the lower A1C guidelines, the diabetes community also received a much needed “got your back” from the ADA.  In this press release they also made this statement: "regardless of age, individuals may require 10 or more strips daily to monitor for hypoglycemia, assess insulin needs prior to eating, and determine if their blood glucose levels [are] safe enough for overnight sleeping."

Can I get a Amen?

How many of us have fought with our insurance companies for more test strips?  How often are we lumped in with the Type 2 community, who when not on insulin require significantly less testing than our children?

I can only hope that insurance companies will see this important announcement and understand that people with Type 1 need to test more, and as a result…we’ll have more stellar, healthier A1C’s.

Here is something I learned last week while attending the ADA convention:

Obviously, the ADA has our best interest at heart.  Though keep in mind, every child is different.  If your child doesn’t feel his or her lows, if your child is especially sensitive to insulin, or if your child has a problem with hypos regardless of their A1C…draw your own damn guidelines with your doctor. 

Because anyone can say anything about whatever they want…but you and your doctor know what’s best for your child.


If you remember anything…remember that.

And just keep doing your best.  You can’t do better than that.


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