Lower A1c among adolescents with lower perceived A1c goal: a cross-sectional survey
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RESEARCH
Open Access
Lower A1c among adolescents with lower perceived A1c goal: a cross-sectional survey Scott A Clements1*, Matthew D Anger2, Franziska K Bishop3, Kim K McFann4, Georgeanna J Klingensmith3, David M Maahs3 and R. Paul Wadwa3
Abstract Background: The International Society for Pediatric and Adolescent Diabetes (ISPAD) and the American Diabetes Association (ADA) have established a hemoglobin A1c (A1c) target of less than 7.5% for adolescents with type 1 diabetes (T1D). However, many adolescents are unaware of their A1c target, and little data exist on how knowledge of this A1c target affects the actual A1c they achieve. We sought to evaluate the relationship between awareness of the A1c target and the actual A1c achieved in adolescents with T1D. Methods: In a cohort of 240 adolescents with T1D age 13–19 years, we measured A1c and administered a questionnaire to assess their knowledge of the ISPAD guideline for A1c target. Results: Of the total cohort, 42 subjects (18%) had an A1c below target and 198 subjects (82%) had an A1c above target. Almost all subjects (98%) reported that they were told their A1c target by a healthcare provider, and most of those (88%) claimed to know their A1c target, but few (8%) were correct. More subjects with actual A1c below 7.5% thought their A1c goal was lower than the ISPAD target, compared to subjects with A1c above target (75% vs. 59%, p = 0.07), although this did not achieve statistical significance. Conclusion: In this cohort of adolescents with T1D, there was a trend toward a lower achieved A1c in those with a lower perceived A1c goal. Further studies should focus on identification of factors influencing an adolescent’s ability to achieve a lower A1c. Keywords: Type 1 diabetes, Hemoglobin A1c, Adolescents
Background Hemoglobin A1c (A1c) is a widely used measure of glycemic control for patients with type 1 diabetes (T1D). Elevated A1c is associated with increased risk of developing microvascular and macrovascular complications, whereas an A1c less than 7.5% is associated with increased hypoglycemia [1-3]. Debate exists regarding the optimal A1c target for adolescents with T1D. Seeking to minimize long-term complications of diabetes, while also minimizing hypoglycemia, the International Society for Pediatric and Adolescent Diabetes (ISPAD) has established an A1c target of less than 7.5% for all children and adolescents with T1D [4]. However, scant data exist on how well adolescents can identify their A1c target or
how knowledge of this A1c target relates to the actual A1c achieved by adolescents [5,6]. One determinant of achieving the A1c target in adolescents may be awareness of this target. If adolescents are aware of the A1c target, they may be more likely to work toward achieving that goal. If they are able to achieve a lower A1c, their risk of developing long-term complications of diabetes decreases. The purpose of this analysis was to determine the relationship between awareness of the A1c target and achievement of that target in a cohort of adolescents wi
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