10
Standards of Medical Care
Glucose Monitoring
Self-Monitoring Blood Glucose (SMBG)
ÎPatients on multiple-dose insulin (MDI) or insulin pump therapy should
do SMBG prior to meals and snacks, occasionally postprandially, at
bedtime, prior to exercise, when they suspect low BG, after treating
low BG until they are normoglycemic, and prior to critical tasks such as
driving. (B)
Î When prescribed as part of a broader educational context, SMBG
results may be helpful to guide treatment decisions and/or patient
self-management for patients using less frequent insulin injections or
noninsulin therapies. (E)
ÎWhen prescribing SMBG, ensure that patients receive ongoing instruction
and regular evaluation of SMBG technique and SMBG results, as well as
their ability to use SMBG data to adjust therapy. (E)
Continuous Glucose Monitoring (CGM)
ÎWhen used properly, CGM in conjunction with intensive insulin regimens
can be a useful tool to lower A1c in selected adults (age ≥25 years) with
type 1 diabetes. (A)
ÎAlthough the evidence for A1c lowering is less strong in children, teens,
and younger adults, CGM may be helpful in these groups.
Note: Success correlates with adherence to ongoing use of the device. (C)
ÎCGM may be a supplemental tool to SMBG in those with hypoglycemia
unawareness and/or frequent hypoglycemic episodes. (E)
A1c
ÎPerform the A1c test at least 2 times a year in patients who are meeting
treatment goals (and who have stable glycemic control). (E)
ÎPerform the A1c test quarterly in patients whose therapy has changed or
who are not meeting glycemic goals. (E)
ÎUse of point-of-care testing for A1c provides the opportunity for more
timely treatment changes. (E)
Table 8. Correlation of A1c with Average Glucose
Mean Plasma Glucose
A1c (%) mg/dL mmol/L
6 126 7.0
7 154 8.6
8 183 10.2
9 212 11.8
10 240 13.4
11 269 14.9
12 298 16.5
