Building Competency in Diabetes Education THE ESSENTIALS

MONITORING| 7-

The 2018 Guidelines recommend the following glycemic targets for children and adolescents with type 1 diabetes (16).

Table 4: Recommended glycemic targets for children and adolescents with type 1 diabetes

Age (years)

Fasting/preprandial PG (mmol/L)

Considerations

A1C (%)

2-hour postprandial PG* (mmol/L)

<18

≤7.5

4.0–8.0

5.0–10.0

Caution is required to minimize severe or excessive hypoglycemia. Consider preprandial targets of 6.0–10.0 mmol/L as well as higher A1C targets in children and adolescents who have had severe or excessive hypoglycemia or have hypoglycemia unawareness.

A1C = glycated hemoglobin; PG = plasma glucose *Postprandial monitoring is rarely done in young children except for those on continuous subcutaneous insulin infusion (CSII) therapy for whom targets are not available. Reproduced with the permission of Diabetes Canada (16)

The target A1C for most children with type 2 diabetes is 7.0% or less (17).

GLUCOSE Monitoring in patients with chronic renal disease Optimal glycemic control decreases the risk of microvascular complications. The UKPDS showed a 34% risk reduction in microalbuminuria as a result of intensive therapy in patients newly diagnosed with type 2 diabetes (10). Similarly, in type 1 patients in the DCCT, there was a 54% reduction in progression to macroalbuminuria (>300 mg/day) (7). However, limited trials have been done to demonstrate the effects of tight glycemic control in patients with diabetes and advanced renal dysfunctionor the effect on the rate of decline in patients with end-stage renal disease (ESRD). However, the evidence does suggest that these patients could benefit from intensive glucosemonitoring. Patients with advanced renal impairmentand diabetes often have other comorbidities that put them at greater risk for hyperglycemia and hypoglycemia (18,19). Insulin requirements may need to be reduced in patients on hemodialysis due to decreased insulin resistance from the dialytic process (20). An important consideration in patients with renal failure is that when GFR is less than 20 mL/min, insulin clearance is markedly reduced; patients may need to test BG levels more often to prevent hypoglycemia (21).