Benefits of glucose control in DM

• The benefits of improved glucose control are reduced risk of microvascular and macrovascular complications, as well as enhanced well-being and overall health

Evaluation of metabolic control: HbA1c

• HbA1c is formed by non-enzymatic glycation of haemoglobin on exposure to glucose
• It increases in a predictable way in response to prevailing glucose, and can be used to measure average glycaemic control over a prolonged period of time (6-8 weeks)
• Currently the standard for assessing overall glucose control
• Does have some limitations
  • Reference ranges vary between laboratories
  • Will decrease in patients with haemaglobin varients e.g. sickle cell
  • Will decrease in haemlytic anaemia, acute or chronic blood loss, pregnancy
  • Doesn't tell you about glycaemic variability - has been linked to increased risk of hypoglycaemia and increased risk of microvascular complications
• Recently added as another criteria for the diagnosis of diabetes (HbA1c ≳6.5%)

HbA1c targets

• Target is < 53 mmol/mol
• In younger individuals with a greater lifetime risk aim for 48 mmol/mol (this is extremely hard to achieve, only minority will reach this)

Carbohydrate counting

• The insulin-to-carb ratio is the amount of rapid acting insulin needed to cover a specific amount of carbohydrate
• The insulin sensitivity factor is used to calculate the drop in glucose for each unit of insulin - also called a 'correction factor'

Blood glucose targets

• Blood glucose should be tested at least 5 times per day

Why are glucose targets important?

• Avoidance of acute complications of diabetes e.g. hypoglycaemia, osmotic symptoms of hyperglycaemia, DKA< and hyperosmolar hyperglycaemic state
• Risk reduction in micro and macrovascular complications
• Pregnancy outcomes