The Evolution of Hemoglobin A1c Targets for Youth With Type 1 Diabetes: Rationale and Supporting Evidence

What is it about?

The American Diabetes Association 2020 Standards of Medical Care in Diabetes recommends a hemoglobin A1C of <7% (53 mmol/ml) for many children with type 1 diabetes (T1D), with an emphasis on target personalization. Here we provide a historical perspective of A1C targets in pediatrics, highlight evidence demonstrating detrimental effects of hyperglycemia in youth, and review data supporting a decrease over time in severe hypoglycemia risk for youth with T1D, and weakened association between lower A1C and severe hypoglycemia risk. Finally, we present common barriers to achieving glycemic targets in pediatric diabetes and discuss some strategies to address them.

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