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TomHsiung
Tue 5th August '14, 8:32pm
First-Ever ADA Guidance Specifically for Type 1 Diabetes

Miriam E. Tucker
June 16, 2014

SAN FRANCISCO — A new position statement from the American Diabetes Association (ADA) provides the first-ever guidance specific to the management of type 1 diabetes in all age groups, including a new HbA1c target for children.
"Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association" was released June 16 at a press briefing held during the American Diabetes Association 2014 Scientific Sessions (http://www.medscape.com/viewcollection/33150) and also simultaneously published online (http://care.diabetesjournals.org/content/early/2014/06/09/dc14-1140.full.pdf+html) in Diabetes Care.
A new pediatric glycemic control target of HbA1c less than 7.5% across all ages replaces previous guidelines that had called for different targets by age (less than 8.5% for children aged under 6 years, less than 8% for those aged 6 to 12 years, and less than 7.5% for adolescents between the ages of 13 and 19 years).

The previous guidance is based on outdated information, Lori M.B. Laffel, MD, chief of the pediatric, adolescent, and young adult section of the Joslin Diabetes Center and associate professor of pediatrics at Harvard Medical School, said at the briefing.
"Those targets were based on experience with severe hypoglycemia in a distant era," Dr. Laffel said, noting that modern technology such as insulin analogs, insulin pumps, and continuous glucose monitoring now allow for tighter control with less risk for hypoglycemia.
Moreover, new evidence suggests that rates of hypoglycemia aren't increased in the youngest patients, nor in those with lower HbA1c levels. And research now shows increased evidence of acute adverse central nervous system effects of hyperglycemia, Dr. Laffel said.

The new HbA1c target of less than 7.5% across all pediatric age groups is now harmonized with that of the International Society for Pediatric and Adolescent Diabetes, the Pediatric Endocrine Society, and the International Diabetes Federation.
The adult HbA1c target of less than 7% for type 1 diabetes remains the same, with individualized lower or higher targets based on patient need.

"We are so pleased to be able to have offered a unified target for the pediatric population and even more pleased to have a single set of guidelines that will cross the entire lifespan for our patients with type 1 diabetes so we can be assured as we pass our patients to our adult providers we will all be singing the same song," Dr. Laffel said.

Source: http://www.medscape.com/viewarticle/826854?src=confwrap&uac=180112PN