The Evolution of Hemoglobin A1C Targets for Youth with Type 1 diabetes: Rationale and Supporting Evidence

The American Diabetes Association 2020 Standards of Medical Care in Diabetes (Standards of Care) recommends a hemoglobin A1C of <7% (53 mmol/ml) for many children with type 1 diabetes (T1D), with an emphasis on target personalization. A higher A1C target of <7.5% may be more suitable for youth who cannot articulate symptoms of hypoglycemia or have hypoglycemia unawareness, and for those who do not have access to analog insulins, advanced diabetes technologies, or cannot monitor blood glucoses regularly. Even less stringent A1C targets (e.g. <8%) may be warranted for children with a history of severe hypoglycemia, severe morbidities, or short life expectancy. During the “honeymoon” period and in situations where lower mean glycemia is achievable without excessive hypoglycemia or reduced quality of life, an A1C <6.5% may be safe and effective