Journal Article

ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes

Acerini, Carlo L., Craig, Maria E., Codner, Ethel, Hofer, Sabine E., Pillay, Kubendran, DiMeglio, Linda A., Maahs, David M.

2018

Overview

Recommendations: Regular self-monitoring of glucose (using accurate fingerstick blood glucose [BG] measurements, with or without continuous glucose monitoring [CGM] or intermittently scanned CGM [isCGM]), is essential for diabetes management for all children and adolescents with diabetes (A). ○ Each child should have access to technology and materials for self-monitoring of glucose measurements to test enough to optimize diabetes care (B). ○ Diabetes center personnel should advocate to nations, states, and health care funders to ensure that children and adolescents with diabetes have adequate glucose monitoring supplies (E). ○ When fingerstick BGs are used, testing may need to be performed 6 to 10 times per day to optimize intensive control. For children, adolescents, and young adults aged ≤25 years we recommend individualized targets, aiming for the lowest achievable HbA1c without undue exposure to severe hypoglycemia balanced with quality of life and burden of care (E). For children, adolescents, and young adults ≤25 years who have access to comprehensive care a target of HbA1c of <53 mmol/mol (7.0%) is recommended (E). ○ A higher HbA1c goal (in most cases <58 mmol/mol [7.5%]) is appropriate in the following contexts: inability to articulate symptoms of hypoglycemia, hypoglycemia unawareness/history of severe hypoglycemia, lack of access to analog insulins, advanced insulin delivery technology, ability to regularly check BG, and CGM (E), and individuals who are “high glycators,” in whom an at-target HbA1c would reflect a significantly lower mean glucose than 8.6 mmoL/L (155 mg/dL) (E). ○ A lower goal (6.5%) or 47.5 mmol/mol may be appropriate if achievable without excessive hypoglycemia, impairment of quality of life, and undue burden of care (E). ○ A lower goal may be appropriate during the honeymoon phase of type 1 diabetes (E). ○ For patients who have elevated HbA1c, a step-wise approach to improve glycemic control is advised including individualized attention to: dose adjustments (E), personal factors limiting achievement of the target (E), assessment of the psychological effect of goal setting on the individual (E), and incorporation of available technology to improve glucose monitoring and insulin delivery modalities (E). Importantly, recent data suggest that lowering HbA1c targets is associated with a decreased mean HbA1c on a population and individual level without an increased frequency of severe hypoglycemia, even in children who achieve HbA1c levels <53 mmol/mol (7.0%).

• Publisher: John Wiley & Sons A/S,John Wiley & Sons, Inc
• Subject: Adolescent / Adolescents / Age Factors / Age of Onset / Blood Glucose - analysis / Blood Glucose - metabolism / Blood Glucose Self-Monitoring - methods / Blood Glucose Self-Monitoring - standards / Child / Children / Consensus / Diabetes / Diabetes mellitus / Diabetes Mellitus - blood / Diabetes Mellitus - epidemiology / Diabetes Mellitus - therapy / Endocrinology - organization & administration / Endocrinology - standards / Glucose monitoring / Glycated Hemoglobin A - analysis / Glycated Hemoglobin A - metabolism / Humans / Hypoglycemic Agents - administration & dosage / International Cooperation / Patient Care Planning - standards / Pediatrics - organization & administration / Pediatrics - standards / Practice Patterns, Physicians' - standards / Societies, Medical - organization & administration / Societies, Medical - standards / Teenagers / Young Adult