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Haemoglobin A1c (HbA1c) has been considered the clinical standard to determine overall glycaemic control. Although valuable as a long-term glycaemic measure, HbA1c does not expose day-to-day and intra-day blood glucose fluctuations.18
HbA1c is a valuable measurement for long-term glycaemic control but does not reveal acute glycaemic variations.
By measuring the percentage of the glycated haemoglobin molecule, HbA1c reveals the level of exposure to blood glucose over the last 2 to 3 months; the greater the exposure, the higher the HbA1c result.16 Reviewing a succession of HbA1c results provides an assessment of a patient’s overall long term glucose exposure. However, HbA1c does not provide information about short-term glucose exposure, glucose variability, episodes of low or high glucose or the risks of acute hypoglycaemia.
Two patients with the same HbA1c can experience different glycaemic swings and may require significantly different treatment approaches.
SMBG reveals critical problems in glycaemic exposure that influence therapy decisions.
Self-monitoring of blood glucose (SMBG) should be incorporated as an important adjunct to HbA1c measurements, offering identification of hypoglycaemic episodes, a distinction between fasting, pre-prandial and postprandial hyperglycaemia and information on glycaemic excursions.
The clinical relevance of identifying and treating hypoglycaemia, postprandial hyperglycaemia and glycaemic variability becomes increasingly significant as studies expose the correlation between unresolved or escalating glycaemic abnormalities and diabetes-related diseases.
the glycaemic pattern assessment revealed by an identification of blood glucose results above or below the target range
low blood glucose
short-term measure of diabetes control; assesses the degree to which blood glucose levels fluctuate from high to low
high blood glucose following a meal
long-term measure of diabetes control; assesses average level of glucose exposure over a 2 to 3 month period
at-home blood glucose testing conducted by people with diabetes, typically with a blood glucose meter