Glycemic Targets

Two primary techniques are available for health providers and patients to assess the effectiveness of the management plan on glycemic control: patient self-monitoring of blood glucose (SMBG) or interstitial glucose and A1C.Continuous glucose monitoring (CGM) may be a useful adjunct to SMBG in selected patients.Recommendations c When prescribed as part of a broader educational context, SMBG results may help guide treatment decisions and/or self-management for patients using less frequent insulin injections B or noninsulin therapies.E c 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.E c Patients on multiple-dose insulin or insulin pump therapy should perform SMBGprior to meals and snacks, occasionally postprandially, at bedtime, prior to exercise, when they suspect low blood glucose, after treating low blood glucose until they are normoglycemic, and prior to critical tasks such as driving.B c When used properly, CGM in conjunction with intensive insulin regimens is a useful tool to lower A1C in selected adults (aged $25 years) with type 1 diabetes.A c 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 c CGM may be a supplemental tool to SMBG in those with hypoglycemia unawareness and/or frequent hypoglycemic episodes.C c Given variable adherence to CGM, assess individual readiness for continuing use of CGM prior to prescribing.E c When prescribing CGM, robust diabetes education, training, and support are required for optimal CGM implementation and ongoing use.E Suggested citation: American Diabetes