Assessing Blood Glucose Control

Using assessment levels to set targets

Use the published assessment levels :
		as an integral part of diabetes care – never manage diabetes on symptoms
		to indicate need for further intervention
		as the basis for short-term and longer-term individualized targets
		as an educational tool to help the person with diabetes
Ask questions of yourself continually :
		Is it possible for the individual to approach each target more closely, without a counter-balancing deterioration in quality of life?
		For what percentage of patients is the service achieving these targets?
Be concerned about targets :
		Failure to attempt to approach the targets more closely is inadequate care, unless this would lead to deterioration in quality of life
		Do not attempt to approach target levels too closely where this adversely affects the quality of life of the person with diabetes

Assessment of blood glucose control

Measure glycated haemoglobin 2-4 monthly in every patient ( depending how stable )

Think of hypoglycaemia if glycated haemoglobin level is normal or close to normal

Use the assessment levels ( below ) to set blood glucose targets

Attention to the non-metabolic target of "diabetes interfering little with the patient's general and social well-being" will help metabolic control

Glucose control assessment levels


	Non-diabetic	Adequate	Inadequate


HbA_1c (DCCT standardized)
%Hb	<6.1	6.2-7.5	>7.5
Self-monitored blood glucose
Fasting / pre-prandial
mmol/l	4.0-5.0	5.1-6.5	>6.5
mg/dl	70-90	91-120	>120
Post-prandial (peak)
mmol/l	4.0-7.5	7.6-9.0	>9.0
mg/dl	70-135	136-160	>160
Pre-bed
mmol/l	4.0-5.0	6.0-7.5	>7.5
mg/dl	70-90	110-135	>135