Monitoring Blood Sugar Control in Children with Diabetes

Primary Monitoring Strategy

The American Diabetes Association recommends that HbA1c should be measured every 3 months in all children and adolescents with type 1 diabetes to assess overall glycemic control 1, 3
For children with type 2 diabetes, glycemic status should similarly be assessed every 3 months using HbA1c, as recommended by the American Diabetes Association 2, 4
The American Diabetes Association has established HbA1c as the cornerstone metric because it reflects average glycemia over the preceding 2-3 months and correlates directly with risk of microvascular complications, as demonstrated in the DCCT trial 3

For type 1 diabetes: The American Diabetes Association recommends an HbA1c target of <7% (53 mmol/mol) for many children, though individualization is necessary 1, 5
For type 2 diabetes: A reasonable HbA1c target is <7% (53 mmol/mol) for most children and adolescents, as recommended by the American Diabetes Association 2, 6
Less stringent targets (<7.5%) may be appropriate for patients with hypoglycemia unawareness, limited access to technology, or nonglycemic factors that increase HbA1c, according to the American Diabetes Association 1, 5

The American Diabetes Association recommends that CGM metrics (time in range, time below/above target) should be used in conjunction with HbA1c whenever possible, not as a replacement 1, 5
Real-time CGM or intermittently scanned CGM should be offered to all children with type 1 diabetes as it lowers HbA1c and increases time in range, as recommended by the American Diabetes Association 1, 8
For type 2 diabetes, CGM should be offered to youth on multiple daily injections or insulin pumps, according to the American Diabetes Association 2, 6

For screening and diagnosis of type 2 diabetes in children, HbA1c may have lower sensitivity than fasting glucose or oral glucose tolerance tests, particularly in certain ethnic populations, as noted by the American Diabetes Association 2, 6
However, for established diabetes monitoring, HbA1c remains the standard regardless of ethnicity, as recommended by the American Diabetes Association 2