Lower A1c among adolescents with lower perceived A1c goal: a cross-sectional survey

Abstract

BackgroundThe International Society for Pediatric and Adolescent Diabetes (ISPAD) and the American Diabetes Association (ADA) have established a hemoglobin A1c (A1c) target of less than 7.5% for adolescents with type 1 diabetes (T1D). However, many adolescents are unaware of their A1c target, and little data exist on how knowledge of this A1c target affects the actual A1c they achieve. We sought to evaluate the relationship between awareness of the A1c target and the actual A1c achieved in adolescents with T1D.MethodsIn a cohort of 240 adolescents with T1D age 13–19 years, we measured A1c and administered a questionnaire to assess their knowledge of the ISPAD guideline for A1c target.ResultsOf the total cohort, 42 subjects (18%) had an A1c below target and 198 subjects (82%) had an A1c above target. Almost all subjects (98%) reported that they were told their A1c target by a healthcare provider, and most of those (88%) claimed to know their A1c target, but few (8%) were correct. More subjects with actual A1c below 7.5% thought their A1c goal was lower than the ISPAD target, compared to subjects with A1c above target (75% vs. 59%, p = 0.07), although this did not achieve statistical significance.ConclusionIn this cohort of adolescents with T1D, there was a trend toward a lower achieved A1c in those with a lower perceived A1c goal. Further studies should focus on identification of factors influencing an adolescent’s ability to achieve a lower A1c.

The role of socio-economic and clinical factors on HbA1c in children and adolescents with type 1 diabetes: an Italian multicentre survey

“…In this study, 28.1% of children with type 1 DM were found at HbA 1c target. The percentage of children achieving HbA 1c target is consistent with other observational studies based on registry data and randomized clinical trials , confirming that HbA 1c levels are often lower in younger patients.…”

Contrasting the clinical care and outcomes of 2,622 children with type 1 diabetes less than 6 years of age in the United States T1D Exchange and German/Austrian DPV registries

“…The Hvidoere study found that differences in glycaemic targets played a significant role in explaining HbA 1c differences between centres [15]. It has also been previously reported that a lower perceived HbA 1c goal is associated with the achievement of lower levels in adolescents with T1D [16]. Thus, it may be more than a coincidence that the proportion of T1DX children meeting the ADA goal of 8.5% (69 mmol/mol) (66%) is close to that of DPV children meeting the 7.5% (58 mmol/mol) ISPAD goal (56%).…”

Lowering targets for hemoglobin A1c in children with type 1 diabetes: raising the bar

“…Percentage difference in the two preschool cohorts of the German–Austrian Diabetes Patienten Verlaufsdokumenation (DPV)‐Registry and the American Type 1 Diabetes Exchange in achieving the respective hemoglobin A1c (HbA1c) goals that were proposed in Europe (<7.5%) and the USA (<8.5%). The odds for achieving either target were greater in the DPV but the difference was much more pronounced for the lower goal, without any difference in the hypoglycemia rates .…”