What is the efficacy of HbA1c measurement for the diagnosis of pediatric type 1 diabetes mellitus (DM)?

Updated: Jul 03, 2019
  • Author: William H Lamb, MD, MBBS, FRCP(Edin), FRCP, FRCPCH; Chief Editor: Sasigarn A Bowden, MD  more...
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Answer

The Diabetes Control and Complications Trial (DCCT) found that patients with HbA1c levels of around 7% had the best outcomes relative to long-term complications. Most clinicians aim for HbA1c values of 7-9%. Values of less than 7% are associated with an increased risk of severe hypoglycemia; values of more than 9% carry an increased risk of long-term complications. The International Society for Pediatric and Adolescent Diabetes (ISPAD) recommends a target level of 7.5% (58 mmol/mol) or less for all children.

Normal HbA1c values vary according to the laboratory method used, but nondiabetic children generally have values in the low-normal range. At diagnosis, diabetic children unmistakably have results above the upper limit of the reference range. Check HbA1c levels every 3 months.

Many different methods of measuring HbA1c are available, and the variations between the different assays can be considerable and unpredictable.

A working group was established in 1995 by the International Federation of Clinical Chemists (IFCC) to find a better method of standardizing the various assays. [48] This resulted in a global standard that is gradually being implemented. As a result, HbA1c will be reported as millimole per mole (mmol/mol) instead of as a percentage. The current target range of 7-9% is set to be replaced with values of 53-75 mmol/mol.


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