Change in hemoglobin A1c one year following the 2014 American Diabetes Association guideline update

In June 2014, the American Diabetes Association lowered recommended hemoglobin A1c (HbA1c) targets from <8.5% (69mmol/mol) for children <6years of age and from <8.0% (64mmol/mol) for children 6-12years of age to <7.5% (58mmol/mol). Lower target HbA1c may lead to better glycemic control but could increase the risk of severe hypoglycemia.

Patients with type 1 diabetes >1year duration, age 0-12years 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.

HbA1c across the age span and within the 0-<6, 6-12, and 0-12year 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±0.5mmol/mol); for 2015, 8.60±0.04 (70±0.5mmol/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).

HbA1c did not change 1year after the updated guidelines despite adoption of the new targets. Assessing changes in severe hypoglycemia may require larger, prospective datasets or longer observation.