Methods to assessment glycemic control
With the increasing incidences of diabetes, maintaining strong glycemic control is important in preventing complications like microvascular and macrovascular as demonstrated my many health researchers. Studies show that, despite the improved knowledge of treating a variety of diseases, it is difficult to maintain the recommended glycemia level in our clinics and only a third of patients achieve the targeted goals. There are methods used mostly in America in assessing the glycemic status of people each method with different level of effectiveness.
Glycated Hemoglobin Testing
Glycated Hemoglobin (Ghb) refers to a series of stable components of minor hemoglobin which forms slowly from glucose and hemoglobin nonenzymatically.The rate of GHb formation is directly proportional to the concentration of glucose.Glycated Hemoglobin Testing (A1C test) is usually used to evaluate the risk of development of chronic complications arising from diabetes diseases for example, cardiovascular disease. According to Di Angelantonio, Gao, Khan, Butterworth, Wormser, Kaptoge, … and Ridker (2014), the permeability of erythrocytes enables the level of GHb in any blood sample to provide a glycemic history from previous 120 days in a patient, which is the average lifespan of the erythrocyte. A1C test is usually reliable for getting the mean plasma glucose for previous 120 days for most individuals. The mean blood glucose assessed between day 1 to day 30 from the time blood sample was taken contributes 50% of the results, while between the first 90 days to 120 days contributes 10% of the results.A1C test is valuable in indicating the effectiveness of treatment and is recommended to be used every 3 months whenever set glycemic targets are hard to achieve or when a patient is in the process of diabetes therapy adjustment.
One disadvantage of A1C test is that it cannot be used independently in predicting the risk development of chronic disease. For optimal use, the A1C test requires standardization, failure to which reported results from laboratories would not be comparable even if laboratories use the same A1C test essay.
Self-Monitoring of Blood Glucose (SMBG)
SMBG is usually recommended to patients in order to maintain the glycemic control targets and prevent hypoglycemic.SMBG is very important modern therapy component as it is possible to maintain a certain level of blood sugar level by taking detailed information of blood glucose many time points. Individuals can respond to values of blood sugar by adjusting their dietary intake, exercise activities and insulin doses that improve glycemic control through which this practice can complement their therapeutic regimen (Saudek Derr and Kalyani, 2006). The benefits of SMBG are many including it provides feedback on results of a lifestyle, it can tell if there is a need for both patients and professional to facilitate long term or short term treatment decisions, and it is essential especially where other tests like A1C are not effective in reflecting glycemia.The disadvantage of SMBG is when the patient lacks knowledge on how to carry out the test or lacks motivation in doing it.This may ignite anxiety and worry about one’s sugar level and the general health status.
Ketones are chemicals released in the body when fats are broken down to provide energy due to lack of insulin. If there is no insulin in the body, the body cannot use glucose as its source of energy. When this condition prolongs, ketones continue to increase which may result in the development of Ketoacidosis which is a life-threatening condition. Ketone secretion is more common in type 1 diabetes than in type 2 diabetes. One can test the level of ketones by use of urine sticks or blood test strips which contain a meter for reading levels of ketones. The health situations under which ketone testing is recommended are, when an individual has type 1 diabetes and experiences acute illness accompanied by high blood sugar and when symptoms of ketoacidosis(DKA) like abdominal pain and nausea prevail (Robyn, David and Vincent Woo, 2013). If the same symptoms appear in patients with type 2 diabetes, then the same test can be considered. During DKA, the balance that usually exists between ketone bodies changes and formation of Beta-Hydroxybutyric Acid (beta-OHB) increasing. Therefore methods that measure levels of this particular component are more useful and effective in providing information. Ketone testing is important in detecting earlier warnings to treat the symptoms earlier. This keeps one from the hospital. However, the blood tests strips are usually expensive, and they require a meter. Also, the procedure may not be covered by medical insurance.
Continuous Glucose Monitoring (CGM)
CGMS is used to measure the glucose level in the interstitial fluid. There are two types of devises for these methods. First is the ‘real time’ CGM which momentarily displays information to the user on the glucose levels and provides alarm notifications upon glucose elevation (Peyrot and Rubin, R.2009). The second devise is the ‘blinded’ CGM.It captures the glucose levels but does not display the readings. Instead, they are downloaded to a computer which are reviewed and analyzed by the healthcare professional.CGM provides best outcomes in association with educative therapeutic programs. The limitation, however, is that it is fully dependent on CGM systems for calibration of CGM devises and so must be used together.
Achieving the glycemic targets has always been a difficult thing that requires the employment of the best method depending on the condition of the patient. Commitment is also a vice especially for SMBG which requires motivation to continually check the glucose levels. Adherence to these methods and doctor’s guideline will keep diabetic patients out of danger.