ASSESSING GLYCEMIC CONTROL
What should be our blood glucose targets for inpatients?
• targets for OUTPATIENTS are between 4-7 mmol/L pre-meal, and 5-10 mmol/L two hrs after eating
TAKE HOME MESSAGES:
for INPATIENTS with NON-CRITICAL illness, there
is NO CONCLUSIVE EVIDENCE that aiming
for these targets is beneficial
• a good guide is to aim for blood glucose between 7-10 mmol/L during hospital admission
• REMEMBER: PREVENTION and AVOIDANCE of HYPOGLYCEMIA is JUST AS IMPORTANT!!!
• measure an A1C (hemoglobin A1C) for every inpatient known to have diabetes (or those in whom you suspect diabetes) to assess for degree of control
• A1C reflects average glycemic control over the previous 3 months
• target A1C is ≤ 7.0% for most patients. In patients with frequent hypoglycemia and/or those in whom hypoglycemia could be detrimental (e.g. elderly, unstable cardiac disease), you may want to be less aggressive in achieving this target
• to help explain to a patient what A1C really means, you can estimate the average blood glucose from the A1C result:
Example: If a patient's A1C is 7.5%, what language could you use to a patient to explain what that means?
estimated avg blood
glucose = (2 x 7.5) - 4
= 11.0 mmol/L
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