Diabetes mellitus type 2 Glycemic control

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Glycemic control is an important measure in diabetes treatment. There are general rules for glycemic control but they should be individualized for every patients based on provider decision and patient condition.

Glycemic control

• Self monitoring of blood glucose (SMBG) is accurate and easy to use by patients. It allows patients to evaluate their individual response to therapy and assess whether glycemic targets are being achieved. SMBG is mostly used for patients with type 1 diabetes mellitus but some patients with type 2 diabetes who require basal insulin will benefit from this method of monitoring.
• Hb A1C reflects average glycemia over approximately 3 months and has strong predictive value for diabetes complications. Therefore, A1C should be measured as baseline control and every 3 month to see whether the treatment goals have been achieved and maintained.

Goals

• A reasonable A1C goal for many nonpregnant adults is ,7% (53 mmol/mol).
• more stringent A1C goals (such as ,6.5% [48 mmol/mol]) for selected individual patients such as, newly diagnosed patients, type 2 diabetes treated with lifestyle or metformin only, long life expectancy, or no significant cardiovascular disease without significant hypoglycemia.
• Less stringent A1C goals (such as ,8% [64 mmol/mol]) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, or long-standing diabetes.
• Preprandial capillary plasma glucose should be ranged between 80 mg/dL (4.4 mmol/L) up to 130 mg/dL (7.2 mmol/L).
• Peak postprandial capillary plasma glucose which is measured 1-2 hours after the beginning of the meal should be kept less than 180 mg/dl (10 mmol/L)