Monitoring Glycemic Control

Abstract

Glycated hemoglobin (A1C) is a valuable indicator of treatment effectiveness and should be measured every 3 months when glycemic targets are not being met and when diabetes therapy is being adjusted. Awareness of both measures of glycemia, self-monitoring of blood glucose (SMBG) results and A1C, provide the best information to assess glycemic control. SMBG should not be viewed as an intervention but rather as an aid to assess interventions and hypoglycemia.Timing and frequency of SMBG should be determined individually based on the type of diabetes, the treatment prescribed, the need for information about blood glucose (BG) levels and the individual's capacity to use the information from testing to modify behaviours or adjust medications. SMBG and continuous glucose monitoring (CGM) should be linked with a structured educational and therapeutic program designed to facilitate behaviour change for improving BG levels.

Nurse-led diabetic retinopathy screening: a pilot study to evaluate a new approach to vision care for Canadian Aboriginal peoples

“…An HbA1c “A1C Now+”™ point-of-care assay provided quantitative measurement of the % of glycated haemoglobin over the last 3 months. The average level of blood glucose in the 30 days immediately preceding the blood sample contributes ~50% of the HbA1c results whereas ~10% is from the past 90–120 days [18,19]. The accuracy of the A1C Now+ was tested on participants who were diabetic and non-diabetic (n=189) in a multiple-site study conducted in the USA, with a 99% accuracy rate found when compared to the National Glycohemoglobin Standardization Program reference results [20].…”

Effect of an Experiential Exercise in Diabetes Management on Pharmacy Students’ Fear and Perceived Pain of Injection and Fingertip Lancing

“…Although we have evidence-based guideline recommendations to help support many of these educational activities, clinician opinions may also influence the advice we provide. 2,3,12,16 For example, clinicians often believe that fear of injections are a critical barrier to introducing insulin in patients with type 2 diabetes and, therefore, may delay introducing this therapeutic alternative. 12,16 However, patients appear to rate other concerns, like addiction to insulin, the complexity of insulin regimens, and perceived restrictions on lifestyle, as more important compared to the fear of injection pain.…”

“…Pharmacists who have active diabetes practices lead these sessions and the content is consistent with current guideline recommendations and training material provided to patients who are starting insulin. 3,14,15 The session runs for 50 minutes with a ratio of 8 students to 1 pharmacist in each session. Students are encouraged to attempt at least one blood glucose check and mock insulin injection while they are directly supervised by the pharmacists.…”

“…1 To help manage the elevated blood glucose levels associated with diabetes, most clinical practice guidelines recommend routine monitoring, an activity that requires fingertip lancing to obtain a small droplet of blood. 2,3 In addition, all patients with type 1 diabetes and some patients with type 2 diabetes require daily insulin injections. Although both activities can help control blood glucose and reduce the risk of diabetes-related complications, [4][5][6] few patients follow the recommendations for self-monitoring of blood glucose.…”

Self-management as a mediator of the relationship between social support and health outcomes of African American adults with type 2 diabetes.

“…Studies showed that diabetes-related complications are prevented by selfmanagement that constitute health-related behavior change (Berard et al, 2013;Chlebowy & Garvin, 2006;Komar-Samardzija, Braun, Keithley, & Quinn, 2012), which enables persons with T2D to control their disease (Haas et al, 2013).…”