Assessing Glycemic Control in Diabetes: From Self Monitoring of Blood Glucose to Continuous Glucose Monitoring System

摘要

The incidence of diabetes is increasing at an alarming rate. Maintaining tight glycemic control is essential to prevent microvascular and macrovascular complications as demonstrated by many studies. Current recommendation for HbAlc is less then 7% and even 6.5% in special individuals. HbAlc measurement is considered the gold standard of diabetes care and serves as a surrogate of diabetes-related complications, but it does not provide information about glycemic excursions. For these reasons, self-monitoring of blood glucose (SMBG) levels is considered an important adjunct to HbAlc measurements for achieving and maintaining glycemic control and consequently for reducing diabetes-related complications. A new method that offers us a complete investigation of glucose excursions is continuous glucose monitoring system (CGMS) that measure glucose concentration in subcutaneous interstitial fluid which can reflect changes in blood glucose concentrations reasonably quickly every 5 min throughout 72 hours (3 days). The aim of this paper was to evaluate the different methods of assessing glucose control in individuals with diabetes melli-tus and to compare themselves in order to establish the clinical relevance. We assessed the glycemic control by HbAlc, SMBG and CGMS Gold simultaneously in a number of 97 individuals with diabetes. 20 individuals have a HbAlc between 6,5 -7,4%, 33 patients between 7,5-8,4%, 15 between 8,5-9,4%, 10 between 9,5 - 10.5% and 7 persons more than 10,5%. It was observed that between HbAlc level and the period spent in glycemic values more than 180 mg/dl there is not a direct relationship as we expected. The same trend was observed in near normal glycemic status but in different way. Assessing of glycemia in diabetes is crucially important to the prevention of both acute and long - term complications. The 3 fundamental approaches to assessment, HbAlc, SMBG and CGM provide fundamentally different but complementary information.