Importance of Blood Glucose Monitoring to Achieve Short and Long-Term Glycemic Control

OBJECTIVE: To review the importance of short- and long-term glucose monitoring in people with diabetes, emphasizing the relationship between elevated fasting and postprandial glucose levels and their association with hemoglobin A1c (HbA1c). DESIGN: Literature review. RESULTS: Numerous epidemiologic and interventional studies have demonstrated that lowering blood glucose to normal or near-normal levels for several years prevents the onset and delays the progression of microvascular complications including retinopathy, nephropathy, and neuropathy. Based on a substantial amount of data, the American Diabetes Association recommends that treatment of all individuals with diabetes be aimed at lowering blood glucose to normal or near-normal levels. CONCLUSIONS: Frequent self-monitoring of blood glucose (SMBG), if used properly, can be effective at improving glycemic control on a day-to-day basis. 5MBG should be done daily and should include measurement of both fasting and postprandial blood glucose levels. Routine measurements of HbA1c are used for measuring long-term control (90 to 120 days) and highly correlate with the incidence and progression of diabetic complications. This makes HbA1 c a valuable clinical tool for both assessing long-term glycemia and predicting risk for the development of chronic complications. Achieving glycemic control through an interdisciplinary, comprehensive diabetes care program is beneficial to the patient and may be cost effective within an integrated health care system. Diabetes should be identified as a target for disease state management programs.