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March 1, 2006

A1c (Glycohemoglobin, HgbA1c), Complications

Question from Buffalo, New York, USA:

What exactly does having high blood sugars/high A1c for a long time do to your body and organs? Does it make them work harder, like cholesterol? There are no studies on long term complications on children that were diagnosed young, like my son. I want to know if I should really try for a lower blood sugar goal of 100 mg/dl [5.6 mmol/L] versus 150 mg/dl [8.3 mmol/L]. He has had no severe hypoglycemia reactions.

Answer:

Sorry, but you are incorrect. There are hundreds of studies about children and adolescents with diabetes and the complications reflect glucose control, just the same as in adults. However, most diabetes complications take many years to show up and, so, the good studies are those that last long enough to demonstrate such differences and have enough patients followed to show these in a statistically meaningful manner. Studies from around the United States, especially Kansas and Pittsburgh, as well as Toronto, are the most powerful for kids and complications. Pirart studies (see The UKPDS: what does it mean…) from France more than 40 years ago showed the same things. Now, studies from Australia, Belgium, Germany, Italy, Japan as well as U.S. and Canada show similar statistical results. Glucose control matters. The sooner that control begins, the better. The longer control is sustained, the better. Avoiding hypoglycemia is a key issue and a difficult one but is do-able in many centers through education and support, frequent monitoring, multidose insulin regimens and also with insulin pumps.

The best place to have you read about this is in Type 1 Diabetes in Children, Adolescents and Young Adults by Ragnar Hanas, M.D. If you want more scientific information, a review article that I wrote several years ago is also available via PubMed. Similar articles have been written by many clinicians/researchers around the world (i.e., Dorothy Becker, Francesco Chiarelli, Denis Daneman, Knut Dahl-Jorgensen, Neil White, Martin Silink, Kim Donaghue, David Dunger, Thomas Danne, Bruno Weber, Harry Dorchy) and can be searched via most medical database search engines and Google, etc.

SB