Hosted by Ray Shields, MD

We recommend that the results of self monitored blood glucose (SMBG) and lab determinations of A1c be available during the clinic visit for therapeutic management decisions. 

A1c

A1c is a “weighted” measure of glycemic control over the preceding 120 days. The more recent days contribute more than the distant days.   The mean level of blood glucose in the 30 days immediately preceding the test contributes about 50% of the final result. 

Lowering A1c is associated with a reduction in microvascular and neuropathic complications of diabetes. We recommend A1c testing in all patients with diabetes to monitor progress toward clinical targets and facilitate therapeutic decision making. 

The A1c goal is <7%.  However, the provider can consider more stringent goals (e.g., <6.5%) for some patients.  A1c testing may be repeated as soon as one month later to assess response to therapy, or every 3-6 months in “stable” patients.  Point-of–care A1c testing allows for timely decisions on therapy changes.

Self Monitoring of Blood Glucose (SMBG)

Patients can use SMBG to achieve and maintain specific glycemic goals. The patient should set reasonable goals on the frequency of testing with the provider.  The provider should review these results with the patient during each visit.   SMBG values can be used for clinical decisions in the timing, dose, and type of therapy, especially for patients on insulin. 
 

Point-of-Care Blood Glucose Testing

Routine office measurement of casual glucose, either capillary or venous, has limited clinical utility.  Ongoing therapeutic decisions cannot be made based on single office testing.