Supplementary Material for: ISPAD Clinical Practice Consensus Guidelines 2024: Glycemic Targets

Summary of what is New or Different

1. This chapter recommends a target HbA1c of ≤6.5% (48mmol/mol) for those who have access to advanced diabetes technologies like continuous glucose monitoring (CGM) and automated insulin delivery (AID). This target should be encouraged for all children and adolescents living with diabetes when safely achievable. In other settings, the HbA1c target is ≤7.0% (53mmol/mol). The emphasis on the lower HbA1c target is deliberate, based on the growing evidence that achieving HbA1c levels below previous targets can significantly reduce the risk of developing diabetes complications and that when adequate technology and healthcare professional support are available, these lower glycemic targets can be safely achieved without increasing the risk of hypoglycemia or adding to the care burdens.
2. These glycemic goals may be individualized based on an assessment of the potential challenges for the person with diabetes and their caregivers.
3. The relationship between glycemic targets and rates of excess body weight are discussed.
4. The glycemic target chapter is also more succinct compared to previous iterations. This chapter is meant to provide updated guidance on overall glycaemic management alongside other ISPAD consensus guidelines that provide further context and information, including specific populations (e.g. pre-schooler children, limited care settings), or situations (e.g. exercise).

新增与差异化内容总结
1. 对于能够使用持续葡萄糖监测（CGM）、自动胰岛素输注（AID）等先进糖尿病管理技术的患者，本章节推荐将糖化血红蛋白（HbA1c）控制目标设定为≤6.5%（48mmol/mol）。在安全可达的前提下，应鼓励所有罹患糖尿病的儿童及青少年采用该控制目标；在其他场景下，糖化血红蛋白控制目标为≤7.0%（53mmol/mol）。本次指南着重推荐更低的糖化血红蛋白控制目标，其依据是日益增多的研究证据表明，将糖化血红蛋白控制在既往目标值以下可显著降低糖尿病并发症的发生风险；且在具备充足技术支持与医护人员专业照护的前提下，达成该低血糖控制目标可安全实现，不会增加低血糖风险或加重照护负担。
2. 上述血糖控制目标可根据糖尿病患者及其照护者所面临的潜在挑战进行个体化调整。
3. 本章节还探讨了血糖控制目标与体质量超重发生率之间的关联。
4. 与既往版本相比，本血糖控制目标章节更为简洁凝练。本章节旨在结合其他国际儿童青少年糖尿病学会（ISPAD）共识指南，为整体血糖管理提供更新后的指导意见——这些共识指南会提供更多背景信息与细节，涵盖特定人群（如学龄前儿童、照护资源有限的场景）或特殊情况（如运动）。