Poor blood glucose control is one of the important risk factors for the development of diabetic retinopathy. The Chinese guidelines for the prevention and treatment of type 2 diabetes contain detailed specifications on the goals and methods of blood glucose control in diabetic patients, which are introduced to patients in the hope of helping them to consciously control their blood glucose and reduce the occurrence and development of diabetic complications.
Blood glucose monitoring
I. Glycosylated hemoglobin
Glycosylated hemoglobin is the most important assessment index for long-term blood glucose control (normal value 4%-6%), and it is also one of the important bases for guiding the adjustment of clinical treatment plan. It is tested ≥1 time/3 months at the beginning of treatment, and once the treatment goal is achieved, it can be checked once/6 months. In patients with abnormal hemoglobin disorders, glycated hemoglobin test results are unreliable and should be based on fasting and/or postprandial venous plasma glucose. If a laboratory is not available, a fingertip capillary glucose assay may be applied, subject to periodic calibration. Such centers should regularly refer patients to the centers that are available for examination, or establish contact with the laboratories of higher centers to forward specimens. Glycosylated hemoglobin measurement should be performed by methods traceable to those once used by the Diabetes Control and Complications Trial (DCCT).
Self-monitoring of blood glucose
Self-monitoring of blood glucose is an important measure to guide blood glucose control to the standard and to reduce the risk of hypoglycemia. Fingertip capillary blood testing is the most ideal method. However, if the conditions do not allow blood glucose testing, urine glucose testing, including quantitative urine glucose testing, is also acceptable. Self-monitoring of blood glucose is applicable to all diabetic patients, and for patients on insulin injections and during pregnancy, self-monitoring of blood glucose is necessary for these patients in order to strictly control blood glucose while reducing the occurrence of hypoglycemia. For those patients who are not on insulin therapy, there is some evidence to suggest that self-glucose monitoring is beneficial in improving glycemic control, but there is also unsupportive evidence.
The frequency of self-monitoring of blood glucose depends on the goals and modalities of treatment for.
1. Patients with poor glycemic control or those with critical condition should be monitored 4-7 times/day until the condition is stabilized and blood glucose is controlled. When the condition is stable or has reached the goal of blood glucose control, it can be monitored 1~2 times/day per week.
2. For those who use insulin therapy, monitor blood glucose ≥ 5 times/day in the beginning stage; after reaching the treatment goal, monitoring shall be 2-4 times/day. After patients using oral medication and lifestyle interventions reach the target, monitor blood glucose 2-4 times/week.
Three, blood glucose monitoring time
1. Pre-meal glucose testing: When the blood glucose level is very high, the fasting glucose level is the first thing to be concerned. Those who have the risk of hypoglycemia (the elderly and those with better blood glucose control) should also measure pre-meal blood glucose.
2.2 hours postprandial blood glucose monitoring: applicable to those whose fasting blood glucose has been well controlled but still cannot reach the treatment target.
3.Bedtime blood glucose monitoring: It is applicable to patients who inject insulin, especially those who inject medium and long-acting insulin.
4.Nocturnal blood glucose monitoring: applicable to those whose insulin treatment is close to the treatment target but whose fasting blood glucose is still high.
5. When symptoms of hypoglycemia appear, blood glucose should be monitored in time.
6. It is advisable to monitor blood glucose before and after strenuous exercise.
IV. Blood glucose monitoring program
1.Patients who use basal insulin should monitor fasting blood glucose 3 days a week before reaching the blood glucose standard, and repeat 1 time/2 weeks, and add 5 points of blood glucose spectrum 1 day before the follow-up; after reaching the blood glucose standard, monitor blood glucose 3 times/week, namely: fasting, after breakfast and dinner, and repeat 1 time/month, and add 5 points of blood glucose spectrum 1 day before the follow-up.
2.For those who use premixed insulin, before reaching the blood glucose standard, monitor fasting blood glucose 3 times a week and blood glucose before dinner 3 times a week, and repeat the examination once/2 weeks, and add 5 points of blood glucose spectrum 1 day before the follow-up examination; after reaching the blood glucose standard, monitor blood glucose 3 times a week, that is: fasting, before and after dinner, and repeat the examination once a month, and add 5 points of blood glucose spectrum 1 day before the follow-up examination.
3.Intensive blood glucose monitoring program for those who do not use insulin therapy: blood glucose monitoring from 5:00 to 7:00 every day, 3 days a week, mainly used during medication adjustment.
4.Low-intensity blood glucose monitoring program for those who do not use insulin therapy: 3 days a week, before and after one meal per day or before breakfast and bedtime 3 days a week, so as to grasp the trend of blood glucose control and understand the effect of meals on blood glucose. If there is suspected asymptomatic hypoglycemia, the focus should be on monitoring the blood glucose before meals.
V. Guidance and quality control of blood glucose monitoring
Before starting self-monitoring of blood glucose, the doctor or nurse should give guidance to diabetic patients on monitoring techniques and monitoring methods, including how to measure blood glucose, when to monitor, monitoring frequency and how to record monitoring results. The physician or diabetes management team should check the patient’s self-monitoring technique and calibrate the blood glucose meter 1~2 times/year, especially when the self-monitoring results are not consistent with glycated hemoglobin or clinical conditions
Comprehensive control goals for type 2 diabetes and treatment pathways for hyperglycemia
Patients with type 2 diabetes are often combined with clinical manifestations of one or more components of the metabolic syndrome, such as hypertension, dyslipidemia, and obesity. With the increase of blood glucose, blood pressure, lipid levels and weight gain, the risk of type 2 diabetes complications, the rate of development and its hazards will increase significantly. Therefore, a scientific and rational treatment strategy for type 2 diabetes based on evidence-based medicine should be comprehensive, including treatment measures such as glucose lowering, blood pressure lowering, lipid regulation, anticoagulation, weight control and lifestyle improvement. Glucose-lowering treatment includes diet control, reasonable exercise, blood glucose monitoring, diabetes self-management education and application of glucose-lowering drugs.