The rationale for paired pre- and postprandial self-monitoring of blood glucose: the role of glycemic variability in micro- and macrovascular risk.
ABSTRACT Decisions regarding diabetes management traditionally have been driven by the results of fasting plasma glucose measurement or measurement of glycosylated hemoglobin (A1C), yet glycemic control remains far from optimal in many individuals with diabetes. Mounting evidence implicates glycemic variability, manifested predominantly as postprandial glycemic spikes, as a key factor in the development of macrovascular complications. Recent studies suggest that newer therapies specifically targeting postprandial hyperglycemia can significantly reduce postprandial glucose levels and improve overall glycemic control.
A Medline search was performed using the term 'postchallenge' or 'postprandial', together with glucose or diabetes. After excluding review articles and case studies, we reviewed primary articles, meta-analyses, and references therein and selected those that best addressed this topic. Selection bias may be considered a potential limitation of this approach.
Although not conclusively demonstrated by prospective studies, a wealth of evidence suggests that postprandial hyperglycemia should not be ignored as an important target for preventing complications of diabetes.
Improved detection and management of postprandial hyperglycemia and glycemic variability is necessary to optimize glycemic control. Meal-based self-monitoring of blood glucose (SMBG) has been shown to improve glycemic control as part of a comprehensive management strategy by helping patients understand the effects of food choices, physical activity, and medications on blood glucose concentrations. SMBG can also help healthcare professionals recognize postprandial hyperglycemia, guide therapeutic adjustments and receive more timely feedback regarding medication changes. The arrival of new therapies that specifically target postprandial hyperglycemia offer healthcare professionals the opportunity to optimally manage diabetes.
SourceAvailable from: ocean.kisti.re.kr[Show abstract] [Hide abstract]
ABSTRACT: Purpose: The aim of the study was to evaluate the effect of self-monitoring of blood glucose (SMBG)-based Diabetes Self-Management Education (DSME) on glycemic control in type 2 diabetes. Methods: This study was designed to compare changes in glycemic control over 12months in SMBG-based DSME group (n=65) versus control group (n=65). Data were obtained from medical records type 2 diabetic patients treated with oral antidiabetic agents and above HbA1c 7.0% from June 2006 to August 2008. All participants completed DSME defined as informational intervention of lifestyle habits and reinforcement of educational Monthly News letter delivered by the diabetes nurse educator. SMBG-based DSME group requested to measure blood glucose 7 times a day for a week and to record their diary and received counseling with a focus on diet and lifestyle during the education. Assessments were conducted baseline, 3, 6 and 12 months. HbA1c was used as an index of glycemic control. Results: 12 months later, the level of HbA1c was reduced by in experimental group and in the control group. We found a significant effect of Group interaction (p=.013). Conclusion: SMBG-based DSME for patients with type 2 diabetes with oral antidiabetic agents was effective in improving glycemic control and maintaining long-term glycemic control.05/2013; 19(2). DOI:10.5977/jkasne.2013.19.2.127
[Show abstract] [Hide abstract]
ABSTRACT: Self-monitoring of blood glucose is an essential component for diabetes self-management, and thus is a fundamental part of the integral treatment of diabetes.Self-monitoring of blood glucose has shown to be beneficial in the metabolic control of the disease, reducing HbA1c, as well as its ability to predict hypoglycaemia and to increase patient awareness of the disease. But there are currently many forms and protocols for the pharmacological treatment of diabetes, thus making recommendations necessary, depending on the treatment, whether self-monitoring should be done or not, and if so, how and when to do this.Our goal, as part of the Expert Working Group of the Spanish Diabetes Society, has been to present standardised and simple recommendations, tailored to each patient group according to their type of treatment and their clinical circumstances. We also present different protocols for self-monitoring that are suitable for type 1 and type 2 diabetics, as well as pregnant women with diabetes.01/2012; 28(1):3–9. DOI:10.1016/j.avdiab.2012.01.002
[Show abstract] [Hide abstract]
ABSTRACT: 1,5-anhydroglucitol (1,5-AG) is a validated marker of short-term glycemic control. It is a metabolically inert polyol that competes with glucose for reabsorption in the kidneys. Otherwise stable levels of 1,5-AG are rapidly depleted as blood glucose levels exceed the renal threshold for glucosuria. 1,5-AG more accurately predicts rapid changes in glycemia than hemoglobin A1C (A1C) or fructosamine. It is also more tightly associated with glucose fluctuations and postprandial glucose. Thus, 1,5-AG may offer complementary information to A1C. This review will summarize the limitations of current methods of assessing glycemic control, assess the data to support 1,5-AG as a glycemic marker and highlight the scenarios by which 1,5-AG may fill the gap in assessing glycemic control.