Volume 1 number 1 Summer 2003
Special issue for the abstracts of the 7th Pan Arab Conference on Diabetes
PACD7 , 25 – 28 March 2003 Cairo

Abstract Number : 33
Assessing Glycemic Control

Christopher D. Saudek, M.D.

The broadest overview of diabetic management includes allowing the patient to feel well, free of symptoms, and avoiding the long-term complications of diabetes. In reaching each of these goals, glycemic control matters; and if glycemic control matters, it must be assessed. Managing diabetes without awareness of blood glucose control is flying blind. 
There are two major approaches to assessing glycemic control in routine clinical use today—self-monitoring of blood glucose (SMBG) and hemoglobin A1c (A1c). They provide very different kinds of information. SMBG, depending on how often it is done, allows the patient and, later, the physician to know a) the immediate blood glucose (to evaluate symptoms or the response to a particular event such as a meal or exercise); b) the patterns of highs or lows; and c) the immediate effect of changing treatment. A1c, on the other hand, provides an assessment of average blood glucose over a long period of time, 2-3 months. It is virtually unaffected by variability in blood glucose, and is not useful for determining immediate response to therapy. But A1c is the basis of most data associating glycemic control with long-term complications. Therefore, in most circumstances, if A1c is in a good range, the patient and physician can be confident that diabetes is being well managed.

Assessment of glycemic control has improved considerably in recent decades, and should improve much more in the future. Challenges include making continuous blood glucose monitoring a practical reality, managing the data gathered by continuous blood glucose monitoring, and ultimately driving insulin delivery by continuous glucose sensing.

OnlineDiabetes Journal, All rights reserved