In a strongly worded review published in a recent
edition of The Journal of the American Medical Association,
the head of the Johns Hopkins Diabetes Center urges
physicians and patients to better use the blood-testing
tools at hand to manage the disease and prevent most of its
dire impact on the heart, kidneys, nerves and vision.
"The message is, we have tools that are very accurate,
but they don't work at all if they are not used properly,"
says Christopher Saudek, a former president of the American
Diabetes Association and lead author of the article. "If
the goal of treatment is to prevent morbidity and
mortality, we need to do a better job of monitoring our
patients, as well as advising them."
Saudek and colleagues reviewed data from studies
conducted between 1976 and 2005 and concluded that both
self-monitoring of blood glucose and more precise physician
testing of hemoglobin A1c, or HbA1c, can help diabetics
take proper control of their blood sugar levels and
successfully manage their disease.
"Used together, self-monitoring and A1c do work," says
Saudek, along with "consistent communication between the
patient and health care professional."
According to the ADA, an estimated 14.6 million people
in the United States have been given a diagnosis of
diabetes, most of them with so-called type 2 or adult
onset. Their disease is marked by the body's inability to
respond to insulin to break down glucose, or sugar.
Saudek said self-monitoring of blood glucose by
patients, according to their condition and type of
diabetes, gives an accurate reflection of immediate blood
glucose levels. HbA1c, however, performed in a doctor's
office or clinic, is a better measure of long-term blood
glucose control, which can be influenced by a number of
physiological and behavioral factors. Saudek also
recommends that diabetics should get their physician to
conduct the HbA1c test every three to six months. The
frequency of self-monitoring depends on the individual case
but can be anywhere from once daily to more than six times
per day. If patients are taking insulin, their treatment
changes or their blood sugar stays too high, the
self-monitoring should be done more frequently.
"The first step in preventing or delaying the onset of
complications associated with diabetes is recognizing the
risk factors, including uncontrolled blood glucose," Saudek
says. "Assessing glycemia in diabetes can be a challenge,
but approaches are available that promote successful
management of blood glucose and may lead to a significant
reduction in incidence and in medical treatment of