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Diabetes Care: Blood Sugar Controlled

Clinical Basis

Patients with well-controlled sugars have better clinical outcomes as well as morbidity and mortality.

Two primary techniques are available for health providers and patients to assess the effectiveness of the management plan on glycemic control: (1) Patient self-monitoring of blood glucose (SMBG) and (2) A1C continuous glucose monitoring (CGM), or interstitial glucose may be a useful adjunct to SMBG in selected patients.

Exclusions

  • Patients with gestational diabetes
  • Patients with steroid induced diabetes

Clinical Guidelines1

  • Refer to endocrinology.
  • Refer all diabetics to diabetes self-management and education counseling at least once.
  • Diabetic patients should be evaluated at least quarterly.
  • Target very poorly controlled diabetics with insulin, when appropriate.

Note: Evidence grades ([X]) are explained above.

  • When prescribed as part of a broader educational context, SMBG results may help to guide treatment decisions and/or self-management for patients using less frequent insulin injections [B] or noninsulin therapies.
  • When prescribing SMBG, ensure that patients receive ongoing instruction and regular evaluation of SMBG technique, SMBG results and their ability to use SMBG data to adjust therapy.
  • When used properly, CGM in conjunction with intensive insulin regimens is a useful tool to lower A1C in selected adults (aged 25 years or older) with type 1 diabetes [A].
  • Although the evidence for A1C lowering is less strong in children, teens and younger adults, CGM may be helpful in these groups. Success correlates with adherence to ongoing use of the device [B].
  • Given variable adherence to CGM, assess individual readiness for continuing CGM use prior to prescribing.
  • Ensure diabetics receive all preventative immunizations (e.g., flu, pneumococcal, zoster vaccine)

1American Diabetes In Standards of Medical Care in Diabetes - 2016. Diabetes Care 2016; 39(Suppl. 1):S39

 

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