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Thread: Glycemic Measurements and Control

  1. #1

    Post Glycemic Measurements and Control

    Two primary techniques are available for health providers and patients to assess the effectiveness of the management plan on glycemic control. They are self-monitoring of blood glucose (SMBG) or interstitial glucose, and A1C.

    SMBG

    The frequency and timing of SMBG should be dictated by the particular needs and goals of the patient.

    For most patients with type 1 diabetes and pregnant women taking insulin, SMBG is recommended three or more times daily. For these populations, significantly more frequent testing may be required to reach A1C targets safely without hypoglycemia and for hypoglycemia detection prior to critical tasks such as driving.

    The optimal frequency and timing of SMBG for patients with type 2 diabetes on noninsulin therapy is unclear.

    However, when interpreting the result of SMBG, factors that can alter self-monitored blood glucose test results should be assessed, as shown in Table 53-18 below.

    Glycemic Measurements and Control-screen-shot-2016-09-17-at-9-11-24-pm-png

    A1C

    A1C is thought to reflect average glycemia over several months, and has strong predictive value for diabetes complications. A1C testing should be performed routinely in all patients with diabetes, at initial assessment and then as part of continuing care. Measurement approximately every 3 months determines whether a patient's glycemic target have been reached and maintained.

    However, the specific frequency of A1C testing should be dependent on the clinical situation, the treatment regimen used, and the judgment of the clinician.

    Note that there is a strong correlation between A1C and average plasma glucose. See the picture below.

    Glycemic Measurements and Control-a1c-and-average-plasma-glucose-png
    (Click the thumbnail to see the full size)
    Last edited by TomHsiung; Sat 17th September '16 at 9:13pm.
    Clinical Pharmacy Specialist - Infectious Diseases

  2. #2
    Pre-pharmD Year 1
    Join Date
    Aug 2013
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    I am agree with you and fundamentally Cardiovascular morbidity is increased in patients with diabetes mellitus and there is a great prevalence of diabetes and heart issues among patients with end-stage renal illness (ESRD). Control of glycemia can decrease cardiovascular and end-organ destroy. Because the validity of glycemic control tests have not been rigorously studied in patients with ESRD, they evaluated the worth of various measures in these patients. The general clinical objective was to inquire in to whether hemoglobin A1C (A1C) exactly reflects actual glycemic control as compared with other measures in light of the importance of attaining appropriately controlled blood glucose (BG).

  3. #3
    PharmD Candidate
    Join Date
    Nov 2013
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    Lucknow, India, India
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    I agree with u guys but SMBG does not always return correct results, based on the user. If the user works the process wrong, or uses devices and other resources that are damaged or outdated, the results can be inaccurate.

  4. #4

    Default Re: Glycemic Measurements and Control

    • Premeal plasma glucose: 70-130 mg/dL (3.885 - 7.215 mmol/L)
    • 2-hour postprandial plasma glucose: <180 mg/dL (<9.99 mmol/L)
    • Bedtime/Overnight (2-4 AM) plasma glucose: >70 mg/dL (>3.885 mmol/L)


    Glycemic Measurements and Control-screen-shot-2016-09-17-at-8-52-47-pm-png

    For Special Populations (A.S.P.E.N. Clinical Guidelines: Nutrition Support of Adult Patients With Hyperglycemia)
    Glycemic Measurements and Control-screen-shot-2016-08-01-at-11-10-35-am-png
    Last edited by TomHsiung; Sat 17th September '16 at 8:55pm.
    Clinical Pharmacy Specialist - Infectious Diseases

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