Glucose Control and Monitoring Urine Testing HbA1c SMBG Guidelines Technique

HbA1c HbA1c 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 reduce microvascular complication, and macrovascular complication A 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

HbA1c Even 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.

HbA1c More 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 - SMBG Optimal 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 regularly Can 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 2. 1. 4. 3.

Techniques - SMBG 6. 5. 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 7.

Urine Testing The correlation between level of glucosuria and blood glucose is weak It is not recommended to do routine urine glucose testing as a means of glucose monitoring The International Diabetes Federation Position Statement (March 2005) stated that urine glucose testing should be available Patients cannot afford or do not wish to perform blood glucose monitoring It is an alternative or complement which can provide valuable information where glucose monitoring is not accessible, affordable, or desired