Table 1.

History of ADA guidance for A1C targets for youth with diabetes since 2000. Years when glycemic target changed are illustrated. Specific changes from the previous goal are indicated in boldface type. A more detailed version of this table is provided as Supplementary Table 1.

Date and publication	Type 1 diabetes	Type 2 diabetes
2000: Type 2 Diabetes in Children and Adolescents (Consensus Statement) (70)		All children: <7%
2003: Standards of Medical Care for Patients With Diabetes Mellitus (71)	Very young children: less stringent treatment goals than the <7% recommended for other individuals
2005: Care of Children and Adolescents With Type 1 Diabetes: A Statement of the American Diabetes Association (72)	Children <6 years: between 7.5% and 8.5%
	Children 6–12 years: <8% (≤8 in the narrative)
	Adolescents (13–19 years): <7.5%
2005: Standards of Medical Care in Diabetes (73)	Plasma blood glucose and A1C goals:
	Toddlers and preschoolers (<6 years)
	Before meals: 100–180 mg/dL
	Bedtime/overnight: 110–200 mg/dL A1C: ≤8.5 (but ≥7.5%)
	School age (6–12 years)
	Before meals: 90–180 mg/dL
	Bedtime/overnight: 100–180 mg/dL
	A1C: <8%
	Adolescents and young adults (13–19 years)
	Before meals: 90–130 mg/dL
	Bedtime/overnight: 90–150 mg/dL
	A1C: <7.5% (a lower goal [<7%] is reasonable if it can be achieved without excessive hypoglycemia)
2006: Standards of Medical Care in Diabetes (74)	Plasma blood glucose and A1C goals:
	Toddlers and preschoolers (0–6 years)
	Before meals: 100–180 mg/dL
	Bedtime/overnight: 110–200 mg/dL
	A1C: <8.5% (but >7.5%)
	School age (6–12 years)
	Before meals: 90–180 mg/dL
	Bedtime/overnight: 100–180 mg/dL
	A1C: <8%
	Adolescents & young adults (13–19 years)
	Before meals: 90–130 mg/dL
	Bedtime/overnight: 90–150 mg/dL
	A1C: <8% (a lower goal [<7.0%] is reasonable if it can be achieved without excessive hypoglycemia)
2007: Standards of Medical Care in Diabetes (75)	Plasma blood glucose and A1C goals:
	Toddlers and preschoolers (0–6 years)
	Before meals: 100–180 mg/dL
	Bedtime/overnight: 110–200 mg/dL
	A1C: <8.5% (but >7.5%)
	School age (6–12 years)
	Before meals: 90–180 mg/dL
	Bedtime/overnight: 100–180 mg/dL
	A1C: <8%
	Adolescents & young adults (13–19 years)
	Before meals: 90–130 mg/dL
	Bedtime/overnight: 90–150 mg/dL
	A1C: <7.5% (a lower goal [<7.0%] is reasonable if it can be achieved without excessive hypoglycemia)
2011: Standards of Medical Care in Diabetes (76)	Plasma blood glucose and A1C goals:
	Toddlers and preschoolers (0–6 years)
	Before meals: 100–180 mg/dL
	Bedtime/overnight: 110–200 mg/dL
	A1C: <8.5% (a lower goal [<8.0%] is reasonable if it can be achieved without excessive hypoglycemia)
	School age (6–12 years)
	Before meals: 90–180 mg/dL
	Bedtime/overnight: 100–180 mg/dL
	A1C: <8% (a lower goal [<7.5%] is reasonable if it can be achieved without excessive hypoglycemia)
	Adolescents and young adults (13–19 years)
	Before meals: 90–130 mg/dL
	Bedtime/overnight: 90–150 mg/dL
	A1C: <7.5% (a lower goal [<7.0%] is reasonable if it can be achieved without excessive hypoglycemia)
2015: Standards of Medical Care in Diabetes (77)	An A1C goal of <7.5% is recommended across all pediatric age-groups.
	Plasma blood glucose and A1C goals across all pediatric age-groups:
	Before meals: 90–130 mg/dL (5.0–7.2 mmol/L
	Bedtime/overnight: 90–150 mg/dL (5.0–8.3 mmol/L)
	A1C: <7.5% (a lower goal [<7.0%] is reasonable if it can be achieved without excessive hypoglycemia)
2016: Standards of Medical Care in Diabetes (78)	An A1C goal of <7.5% (58 mmol/mol) is recommended across all pediatric age-groups.
	Blood glucose across all pediatric age-groups:
	Before meals: 90–130 mg/dL (5.0–7.2 mmol/L)
	Bedtime/overnight: 90–150 mg/dL (5.0–8.3 mmol/L)
	A1C: <7.5% (58 mmol/mol) (a lower goal [<7.0%] is reasonable if it can be achieved without excessive hypoglycemia)
2018: Evaluation and Management of Youth-Onset Type 2 Diabetes: A Position Statement by the American Diabetes Association (79)		<7% (most youth). More stringent A1C goals (such as <6.5%) may be appropriate for selected individual patients if they can be achieved without significant hypoglycemia or other adverse effects of treatment. Appropriate patients might include those with short duration of diabetes and lesser degrees of β-cell dysfunction and patients treated with lifestyle or metformin only who achieve significant weight improvement. E
2019: Standards of Medical Care in Diabetes (8)		Incorporated the recommendations in the 2018 Position Statement
2020: Standards of Medical Care in Diabetes (7)	Recommendation 13.21: A1C goals must be individualized and reassessed over time. An A1C of <7% (53 mmol/mol) is appropriate for many children. B	<7% (53 mmol/mol) (most youth); <6.5% (48 mmol/mol] (selected youth as specified in 2019 Standards of Care). Less stringent A1C goals (such as 7.5% [58 mmol/mol]) may be appropriate if there is increased risk of hypoglycemia.
	Recommendation 13.22: Less stringent A1C goals (such as <7.5% [58 mmol/mol]) may be appropriate for patients who cannot articulate symptoms of hypoglycemia; have hypoglycemia unawareness; lack access to analog insulins, advanced insulin delivery technology, and/or continuous glucose monitors; cannot check blood glucose regularly; or have nonglycemic factors that increase A1C (e.g., high glycators). B
	Recommendation 13.23: Even less stringent A1C goals (such as <8% [64 mmol/mol]) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, or extensive comorbid conditions. B
	Recommendation 13.24: Providers may reasonably suggest more stringent A1C goals (such as <6.5% [48 mmol/mol]) for selected individual patients if they can be achieved without significant hypoglycemia, negative impacts on well-being, or undue burden of care, or in those who have nonglycemic factors that decrease A1C (e.g., lower erythrocyte life span). Lower targets may also be appropriate during the honeymoon phase. B