Change in hemoglobin A1c one year following the 2014 American Diabetes Association guideline update. (July 2017)

• Record Type: Journal Article
• Authors: Alonso, G. Todd; Pyle, Laura; Frohnert, Brigitte
• Is Part Of: Diabetes research and clinical practice. Volume 129(2017)
• Page Start: 169
• Page End: 172
• Publication Date: 2017-07
• Subjects: HbA1c Hemoglobin A1c -- ADA American Diabetes Association -- ISPAD International Society for Pediatric and Adolescent Diabetes -- CGM continuous glucose monitor -- CSII continuous subcutaneous insulin infusion -- MDI multiple daily injection -- SSI sliding-scale insulin; Pediatrics -- Type 1 diabetes -- HbA1c; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2017.03.033
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: HbA1c did not decrease in children <12 years of age. There was no increased reporting for severe hypoglycemic events. There were significant changes in payer mix and insulin regimen. Abstract: Aims: In June 2014, the American Diabetes Association lowered recommended hemoglobin A1c (HbA1c) targets from <8.5% (69 mmol/mol) for children <6 years of age and from <8.0% (64 mmol/mol) for children 6–12 years of age to <7.5% (58 mmol/mol). Lower target HbA1c may lead to better glycemic control but could increase the risk of severe hypoglycemia. Methods: Patients with type 1 diabetes >1 year duration, age 0–12 years and seen in our center between January 1 and June 30, 2014 or between January 1 and June 30, 2015 were included. 1013 unique patients had 2684 encounters. We analyzed first quarterly HbA1c (January-March, April-June) and self-reported severe hypoglycemia at all clinic encounters. Results: HbA1c across the age span and within the 0–<6, 6–12, and 0–12 year old groups did not differ in the insurance adjusted mixed-effects model. Least squares means for all patients' HbA1c in 2014 was 8.59 ± 0.04 (70 ± 0.5 mmol/mol); for 2015, 8.60 ± 0.04 (70 ± 0.5 mmol/mol) (p = 0.90). Severe hypoglycemia data fields were more complete in 2015 (43% vs 50%). Logistic regression adjusting for follow up showed no difference in severe hypoglycemia for all ages (p = 0.80). Conclusions: HbA1c did not change 1 year after the updated guidelines despite adoption of the new targets. Assessing changes in severe hypoglycemia may require larger, prospective datasets or longer observation.