June 21, 2002
A1c (Glycohemoglobin, HgbA1c)
Question from Philadelphia, Pennsylvania, USA:
I keep reading that the accepted A1c of less than 7% is no longer considered excellent control, and that some doctors would like to see their patients less than 6.5%. Is this a realistic expectation? Does it apply only to adults? What do you consider good control for a four year old?
Also, I have heard that long term complications from poor control does not begin until after puberty. Is tight control a “must” for a young child? My child’s doctor thinks an A1c under 8.5% (normal: less than 6.2%) is acceptable. Do you agree or think young children should also be under 7%?
The lower the hemoglobin A1c, the fewer the complications, but the greater the frequency and severity of hypoglycemia. So, there is a therapeutic dilemma and some compromise must take place — especially in those very young.
The original information about prepubertal kids with diabetes not having complications came from studies in Pittsburgh, but has been refuted by other studies in Berlin, Brussels, Sydney and Leicester. It takes time for diabetes complications to become evident, however, and this may explain the discrepancy. You should work to get best possible control with the least hypoglycemia.