International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2024: Glycemic Targets

Martin de Bock^{1

2}, Juliana Chizo Agwu³, Matt Deabreu⁴, Klemen Dovc⁵, David M Maahs⁶, M Loredana Marcovecchio⁷, Farid H Mahmud⁸, Yeray Nóvoa-Medina⁹, Leena Priyambada¹⁰, Carmel E Smart^{11

12}, Linda A DiMeglio¹³

Affiliations

¹ Department of Paediatrics, University of Otago, Christchurch, New Zealand.
² Department of Paediatrics, Te Whatu Ora, Waitaha, New Zealand.
³ Department of Paediatrics, Wye Valley NHS Trust, Hereford, UK.
⁴ Parent and Advocate of Child with Type One Diabetes, Toronto, Ontario, Canada.
⁵ University Medical Centre Ljubljana, University Children's Hospital, Department of Endocrinology, Diabetes and Metabolic Diseases and University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia.
⁶ Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, California, USA.
⁷ Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁸ Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
⁹ University Institute of Biomedical and Healthcare Research (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain, yeraynm@hotmail.com.
¹⁰ Department of Pediatric Endocrinology, Rainbow Children's Hospital, Hyderabad, India.
¹¹ Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.
¹² School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia.
¹³ Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA.

PMID: 39701064
PMCID: PMC11854972
DOI: 10.1159/000543266

Practice Guideline

International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2024: Glycemic Targets

Martin de Bock et al. Horm Res Paediatr. 2024.

. 2024;97(6):546-554.

doi: 10.1159/000543266. Epub 2024 Dec 19.

Authors

Affiliations

¹ Department of Paediatrics, University of Otago, Christchurch, New Zealand.
² Department of Paediatrics, Te Whatu Ora, Waitaha, New Zealand.
³ Department of Paediatrics, Wye Valley NHS Trust, Hereford, UK.
⁴ Parent and Advocate of Child with Type One Diabetes, Toronto, Ontario, Canada.
⁵ University Medical Centre Ljubljana, University Children's Hospital, Department of Endocrinology, Diabetes and Metabolic Diseases and University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia.
⁶ Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, California, USA.
⁷ Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁸ Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
⁹ University Institute of Biomedical and Healthcare Research (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain, yeraynm@hotmail.com.
¹⁰ Department of Pediatric Endocrinology, Rainbow Children's Hospital, Hyderabad, India.
¹¹ Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.
¹² School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia.
¹³ Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA.

PMID: 39701064
PMCID: PMC11854972
DOI: 10.1159/000543266

Abstract

The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This chapter builds on the 2022 ISPAD guidelines, and updates recommendations on the glycemic targets for children and adolescents living with diabetes. A new target for hemoglobin A1c (HbA1c) of ≤6.5% (48 mmol/mol) is recommended for those who have access to advanced diabetes technologies like continuous glucose monitoring and automated insulin delivery. This target should be encouraged for all children and adolescents living with diabetes when safely achievable. In other settings, the HbA1c target is ≤7.0% (53 mmol/mol). The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This chapter builds on the 2022 ISPAD guidelines, and updates recommendations on the glycemic targets for children and adolescents living with diabetes. A new target for hemoglobin A1c (HbA1c) of ≤6.5% (48 mmol/mol) is recommended for those who have access to advanced diabetes technologies like continuous glucose monitoring and automated insulin delivery. This target should be encouraged for all children and adolescents living with diabetes when safely achievable. In other settings, the HbA1c target is ≤7.0% (53 mmol/mol).

Keywords: Burden; Diabetes-related complications; Glycemic targets; Technology.

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Conflict of interest statement

M.B. received research funding from Novo Nordisk, Medtronic, Ypsomed, Dexcom, and Insulet; honoraria, travel expenses, or speaking fees from Novo Nordisk, Sanofi, Pfizer, Medtronic, Boehringer Ingelheim, Ypsomed, Dexcom, and Insulet; and advisory boards for Tandem and Dexcom, Nascence technology, and Tautoko Biomedical. K.D. received honoraria for participation in the speaker’s bureau of Abbott, Eli Lilly, Medtronic, Novo Nordisk A/S, and Pfizer and advisory board for Medtronic and Novo Nordisk. D.M.M. received research support from the NIH, JDRF, NSF, and the Helmsley Charitable Trust, and his institution has had research support from Medtronic, Dexcom, Insulet, Bigfoot Biomedical, Tandem, and Roche. D.M.M. has consulted for Abbott, Aditxt, the Helmsley Charitable Trust, Lifescan, Mannkind, Sanofi, Novo Nordisk, Eli Lilly, Medtronic, Insulet, Dompe, BioSpex, Provention Bio, Kriya, Enable Biosciences, and Bayer. F.H.M. received research support from the Canadian Institute for Health Research (CIHR), Physicians Services Incorporated, Heart and Stroke Foundation, Diabetes UK, and Breakthrough Diabetes (formerly JDRF). C.E.S. received speaker honoraria from Medtronic and Eli Lilly and advisory boards for Abbott. M.L.M. received research support from the NIH, JDRF, and the Helmsley Charitable Trust. Her institution has received research support from Dompe, Lilly, Mannkind, Medtronic, Provention Bio, Sanofi, and Zealand. L.A.D. has consulted for Abata, Tandem, Biomea Fusion, and Vertex. She also received payment from Sanofi for a CME talk (content independently developed by her). J.C.A., M.D., Y.N.-M., and L.P. have no conflicts of interest to declare.

Figures

**Fig. 1.**
Summary of glycemic metrics. *For those who do not have access to advanced technologies or unable to safely attain the lower target. ^‡And/or where the pursuit of the lower target does not add burden such that quality of life is impacted. DCCT, diabetes control and complications trial; TITR, time in tight range.

See this image and copyright information in PMC

References

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International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2024: Glycemic Targets

Affiliations

International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2024: Glycemic Targets

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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Medical