Our daughter will be five years old at the end of the month and is coming up on the one year diagnosis of her type 1 diabetes. She’s had two A1cs done since she was diagnosed. Her first one in January was 7.7% and, at the end of April, it was 8%. Her pediatric endocrinologist says that those numbers are good for her age. I’ve read in various studies that young kids are usually not affected by diabetes complications until they reach puberty. What are your thoughts on that? I know there have been studies in Europe that contradict those findings. Can a person go through life with good A1cs and still develop complications?

The issue of complications in kids is very complicated. Genetic/family factors are important, but the most important factor remains glucose control. The A1c is a surrogate measurement of glucose control and, thus, is used in most studies. The key study in the United States is from Pittsburgh more than ten years ago and has been refuted quite dramatically in Berlin, Sydney, Brussels, Italy and the United Kingdom, so it is puzzling why some still believe that kids are not at risk when A1c levels are high. What is clear, however, is that kids don’t show the major complications since they take 10-15-20 years to really show up. When very sensitive methods are used, however, kids also have some changes as they move into puberty. Therefore, many of us believe that control of glucose remains very important even in kids since they are laying the groundwork for such complications as teens and early adults. The key question remain how to improve A1c levels and day to day glucose values while avoiding hypoglycemia episodes.

SB