Glucose control levels and self-monitoring
These recommendations are presented in abbreviated form. Readers should refer to the text of the guideline document for a detailed discussion of each of the following topics.
Glucose Control Levels
Recommendations
- Advise people with diabetes that maintaining a DCCT-aligned HbA1c below 6.5 % should minimize their risk of developing complications.
- Provide lifestyle and education support, and titrate therapies, to enable people with diabetes to achieve a DCCT-aligned HbA1c below 6.5 % (where feasible and desired), or lower if easily attained.
- Advise those in whom target HbA1c levels cannot be reached that any improvement is beneficial.
- Sometimes raise targets for people on insulin or sulfonylurea therapy in whom attainment of tighter targets may increase the risk of hypoglycaemic episodes, which may present particular problems for people with other physical or mental impairment.
- Equivalent target levels for capillary plasma glucose levels are <6.0 mmol/l (<110 mg/dl) before meals, and <8.0 mmol/l (<145 mg/dl) 1-2 h after meals.
Self-monitoring
Recommendations
- Self-monitoring of blood glucose (SMBG) should be available for all newly diagnosed people with Type 2 diabetes, as an integral part of self-management education.
- SMBG (using meter and strips) on an ongoing basis should be available to those on insulin treatment.
- SMBG should be considered on an ongoing basis for people using oral agents, but not insulin, where it is used:
- to provide information on hypoglycaemia
- to assess glucose excursions due to medications and lifestyle changes
- to monitor changes during intercurrent illness.
- SMBG should be considered on an intermittent basis for people not using insulin or oral agents, where it is used:
- to assess glucose excursions due to lifestyle changes
- to monitor changes during intercurrent illness.
- Structured assessment of self-monitoring skills, the quality and use made of the results obtained, and of the equipment used, should be made annually.