Why is this important?
- Self-monitoring of blood glucose (SMBG) is useful especially for patients on insulin and for pregnant patients with diabetes.
- Patients prescribed a SMBG regimen should be educated initially and then periodically on SMBG technique and on how to use the data to adjust their diet/exercise/medication.
- SMBG results should be reviewed with patients at each diabetes visit.
- Early intensive treatment of diabetes reduces long-term risk for microvascular disease, heart attacks and death.
- Achieving HbA1c (A1C) targets is an important priority. It can be challenging to reach those targets with lifestyle changes and medication.
- A1C targets should be individualized:
- In general, the A1C target is <7% in non-pregnant patients.
- Aggressive glycemic control (A1C <6.5%) has been shown to further decrease the risk of microvascular complications and may have long-lasting benefits (“legacy effect”).
- However, recent studies have shown that intensive control in older patients and those with multiple comorbidities may pose hazards.
Diabetes Diagnosis (dx)
Target Blood Glucose Levels**
- Fasting and premeal blood glucose target =70 to 130 mg/dL
- Peak postprandial blood glucose target <180 mg/dL
- A1C target <7%
**Individualize targets based on patient characteristics (e.g., age, life expectancy, comorbid conditions including advanced CVD or microvascular complications, social situation).