Glucose Control and Monitoring

HbA1c SMBG

Guidelines Technique

Urine Testing

HbA1cHbA1c measures glycaemic effect on haemoglobin

over preceding 2 – 3 months and has strong predictive value for diabetic complications

HbA1c goal of < 7% is in general appropriate. This target level has been shown to reducemicrovascular complication, andmacrovascular complicationA less stringent HbA1c target may however, be more

appropriate for those patients with advanced diabetic complications especially if there is a history of severe hypoglycaemia and in the very frail elderly

HbA1cEven lower HbA1c values (say around 6.5%) can be

considered for selected younger individuals with short history of diabetes, long life expectancy, and no significant cardiovascular disease, if achievable with a simple drug regimen and without significant risk of hypolglycaemia or adverse effect of treatment.

Studies show that HbA1c values closer to normal improve microvascular outcomes and reduce albuminuria.

HbA1c measured half yearly should be used as an indicator for blood glucose control and the use of fructosamine as a routine substitute for HbA1c is not recommended.

HbA1cMore frequent measurements at quarterly

intervals may be considered for unstable cases or during change in therapeutic regime.

Limitations:Conditions affecting red blood cell lifespan may alter

HbA1c levels, for example acute or chronic blood loss, hemolysis, iron deficiency or vitamin B12 deficiency anaemia and splenectomy. Haemoglobin variants may also interfere with accurate HbA1c values

HbA1c is not able to give a measure of glycaemic variability or hypoglycaemia.

Guidelines – Self-monitoring of blood glucose (SMBG)

SMBG is recommended in patients with Type 2 diabetes who are using insulin and have been educated in appropriate alterations in insulin dose or who are at increased risk of hypoglycaemia.

It helps to monitor for and prevent asymptomatic hypoglycaemia and hyperglycaemia

There is no common consensus in the use of SMBG in people with non-insulin therapies, because of inconsistent results from studies. However, the data available from randomized controlled trials suggest that SMBG is likely to be an effective self-management tool and improve glycaemic control when results are reviewed and acted upon by health care providers and/ or people with diabetes to actively modify behaviour and/ or adjust treatment.

Guidelines - SMBGOptimal use of SMBG：

Adequate patient education given by health care professionals.

Patients should be taught：Correct SMBG techniques, and How to use the data to adjust food intake, exercise or pharmacological therapies

The factors affecting blood glucose results such as illness, stress, alteration of treatment regimens, food intake, exercise, problems regarding techniques of performing SMBG should be taken into account

The frequency and timing of SMBG should be addressed to the particular needs and goals of people with diabetes

It should be individualized and negotiation is needed

Guidelines - SMBG Guidelines from the International Diabetes Federation(IDF)

for non-insulin treated patients with type 2 diabetes recommends： Low intensity SMBG should be used in early education of

patients, and to be performed regularlyCan help patients understand the effects of treatment on their

blood glucose levels, assist clinicians to identify post-prandial hyperglycaemia, fasting hyperglycaemia as well as asymptomatic hypoglycaemia.

In addition, patients should learn to perform short-term focused SMBG, which may be useful in certain circumstances, such as when patients have symptoms of hypoglycaemia, ongoing infections, are travelling or under stress, undergo adjustment of medications/ nutrition/ physical activity, entering new life experience, starting new jobs etc., when experiencing worsening HbA1c, or when additional information is required about nature of disease/ impact of treatment, in patients who are pregnant or planning to become pregnant.

Techniques - SMBG

1.

2.

3.

4.

Techniques - SMBG

5.6.

7.

Suggested target blood glucose values by the American Diabetes Association

Target blood glucose value (mmol/ L)

Preprandial/ Fasting

3.9 – 7.2

Postprandial 1 – 2hrs < 10

Urine TestingThe correlation between level of glucosuria and

blood glucose is weakIt is not recommended to do routine urine

glucose testing as a means of glucose monitoringThe International Diabetes Federation Position

Statement (March 2005) stated that urine glucose testing should be availablePatients cannot afford or do not wish to perform

blood glucose monitoringIt is an alternative or complement which can provide

valuable information where glucose monitoring is not accessible, affordable, or desired