From Toronto, Canada:
My 17-year-old son, diagnosed with type 1 at the age of 13, has been on a pump for over three years. Beyond the A1c, which he has every four months, what other detailed blood/urine work or other function tests should be performed and how often? What are the best standards of care? How often should his eyes be checked and by what type of doctor?
His A1c has been running between 7 and 7.3. What is the optimal, good and bad range for this number? I've been told he is doing well; is he? Does the number and range vary by the testing equipment?
These are excellent and very basic questions. You should ask them to your son's own diabetes team. The Canadian Diabetes Association has its own Clinical Practice Guidelines while the American Diabetes Association has its own Standards of Medical Care for Patients With Diabetes Mellitus. And, guidelines are not the same as Standard of Care.
Ideally, many advocate that A1c values be obtained quarterly (every three months), but this is not always possible.
For type 1 diabetics, many would advocate for yearly screening for other common autoimmune diseases that tend to co-exist with type 1 diabetes. This includes thyroid diseases (overactive and underactive) and celiac disease (an intestinal disorder that interferes with absorption of wheat and similar grains). A lipid profile should probably be checked annually as should urine screening for microalbumin excretion. He should have a formal dilated eye exam yearly now by an ophthalmologist.
His A1c values of 7 to 7.3% are pretty good. Normal is less than 6.0%. He should start aiming for a goal to maintain them under 7.5% and probably under 7%. As he gets older, the goal will be less than 6.5%.
Talk to your doctors about their own recommendations.
Original posting 6 Feb 2008
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