ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes

Greater parental comfort with lower glucose targets in young children with Type 1 diabetes using continuous glucose monitoring

“…Importantly, parents of very young children with Type 1 diabetes who used CGM reported being comfortable with significantly lower minimum glucose values than parents who relied solely on intermittent blood glucose measurements. These lower minimum glucose values fall within the ranges in the ADA and ISPAD guidelines, but above the recommended absolute threshold for a low value .…”

“…During the past 5–6 years there have been several changes in care for young children with Type 1 diabetes. The American Diabetes Association (ADA) lowered glycaemic targets to <58 mmol/mol (<7.5%) , the International Society for Paediatric and Adolescent Diabetes (ISPAD) lowered targets to <53 mmol/mol (<7.0%) , improved CGM systems with remote monitoring were introduced, and levels of CGM and insulin pump use in young children rose . Nevertheless, whether parents of very young children are using additional glucose information and advanced diabetes technologies to attempt to achieve lower glycaemic targets has not been established.…”

Prospective evaluation of insulin‐to‐carbohydrate ratio in children and adolescents with type 1 diabetes using multiple daily injection therapy

“…During hospitalization, blood glucose levels were measured using fingerstick blood glucose meters eight times daily: before and 2 hours after each meal, at bedtime and at 3 am The basal insulin doses were adjusted to keep fasting blood glucose levels before breakfast between 70 and 130 mg/dL without nocturnal hypoglycemia. The nocturnal blood glucose was assess by glucometer measurements at bedtime, 3 am and before breakfast with overnight blood glucose target between 80 and 162 mg/dL . Meal omission test was done to confirm the accuracy of the basal dose.…”

“…ISF is defined as the reduction in blood glucose level in mg/dL that can be achieved by 1 unit of short‐acting or rapid‐acting insulin . ISF was initially calculated using 1800/TDD formula then adjusted according to blood glucose measurements aiming at returning blood glucose level to the target range (90‐180 mg/dL) 2 hours after the bolus dose …”

ISPAD Clinical Practice Consensus Guidelines 2018: What is new in diabetes care?

“…The “Glycemic control targets and glucose monitoring” chapter has been updated to reflect the major advances that have occurred regarding blood glucose monitoring, and technology . An individualized approach to the patient is emphasized and a decrease in “target” HbA1c to <7% is recommended for those using the new technologies consistent with the goal for children, adolescents, and young adults with type 2 diabetes.…”