A tighter target for blood glucose control in children with diabetes has been recommended by the National Institute for Health and Care Excellence.
The new target for long-term blood glucose levels should be 48mmols/mol (6.5%) and below, according to NICE – a reduction from the previous target of 58mmols/mol (7.5%) and below.
But charities warned that patients would need “appropriate support” to reach the tighter target, as the majority of children were currently failing to meet the old one.
“We know that reaching and maintaining near normal blood glucose levels is difficult, but it reduces the tissue damage caused by high blood glucose”
The revised HbA1c target was revealed yesterday in new NICE guidance on diagnosing and treating diabetes in children and young people.
Dr Julie Edge, a consultant in paediatric diabetes at Oxford Children’s hospital who helped write the guideline, noted that it was the first time an HbA1c level “near the normal range and nearly normal daily blood glucose readings” had been recommended for children and young people.
She said: “We know that reaching and maintaining near normal blood glucose levels is difficult, but it reduces the tissue damage caused by high blood glucose, and so may avoid the long-term health problems caused by diabetes. It also reduces the risk of diabetic ketoacidosis which can be fatal.”
Dr Edge said that achieving such “tight control” would require “intensive insulin management” with multiple daily injections or insulin pump therapy, in addition to carbohydrate counting – matching the amount of insulin with the amount of carbohydrate eaten.
She added: “Because the ideal HbA1c target level of 48mmol/mol (6.5%) or lower is hard to achieve, it is important that children and young people do not feel pressurised, and individual targets are discussed.
“Diabetes teams should provide all the help that children and young people need to stay as healthy as possible, including psychological support,” she said.
Barbara Young, chief executive of Diabetes UK, said it was important that steps were taken to ensure “appropriate support” was put in place to help children and their families achieve the tighter HbA1c target recommended by NICE.
“We know that the majority of children with type 1 diabetes already struggle to achieve current blood glucose targets with the most recent figures revealing that less than one in five manage this,” she said.
“While the technology, such as pumps and increased access to continuous blood glucose monitors, is available to support children with type 1 diabetes reach blood glucose targets, it is critical that they receive the emotional support – such as improved access to specialist psychological care – they and their families need to feel empowered to achieve these new targets,” she added.
“We know that the majority of children with type 1 diabetes already struggle to achieve current blood glucose targets with the most recent figures revealing that less than one in five manage this”
Other recommendations in the guidance said children and young people with suspected type 1 should be “immediately” referred – on the same day – to a multi-disciplinary paediatric diabetes team with the “competencies needed to confirm diagnosis”.
Real-time continuous glucose monitoring with alarms should be offered to children with type 1 who have frequent severe hypoglycaemia, those with impaired awareness of hypoglycaemia due to seizures or anxiety, or the inability to recognise or communicate about it.
In addition, children and young people with type 2 diabetes should receive a continuing programme of education from diagnosis, said NICE.
It should cover “core topics” including HbA1c monitoring and targets, the effects of diet, exercise, body weight and illness on blood glucose control, the aims of metformin therapy and possible adverse effects, and also diabetes complications and how to prevent them.
NICE added that the 2013-14 National Diabetes Audit had identified 26,500 children and young people with type 1 diabetes and 500 with type 2, but both types were becoming more common.