Monitoring glycemic control: the cornerstone of diabetes care.
BACKGROUND
Diabetes mellitus is associated with significant morbidity and mortality and escalating costs, and its prevalence is increasing to epidemic proportions. Studies have consistently documented the importance of glycemic control in delaying the onset and decreasing the incidence of both the short- and long-term complications of diabetes. Although glycemic control is difficult to achieve and challenging to maintain, its impact on disease outcomes is well worth the effort.


OBJECTIVE
This article reviews the importance of monitoring and tightly controlling blood glucose concentrations in patients with diabetes and the methods and tools available for achieving these goals.


METHODS
This clinical review was developed using 102 a MEDLINE search of the literature from 1990 to 2005 using the terms diabetes, glucose control, glucose monitoring, A(1c), and hypoglycemia.


RESULTS
The complications of diabetes can be prevented or sharply curtailed through tight glycemic control, which requires frequent monitoring of blood glucose levels, careful attention to diet and exercise, and the use of medications. The progressive nature of diabetes imposes the need for frequent and regular monitoring, leading to data-driven adjustments to therapy to maintain optimal glucose levels. Failure to achieve glycemic control is often the result of a failure to educate the patient about how to monitor blood glucose levels and the importance of accuracy in doing so.


CONCLUSIONS
Tight glycemic control requires an 102 educated and motivated patient, an appropriate treatment regimen, vigilant monitoring, and a close partnership between the patient and a multidisciplinary team of health care professionals to ensure accurate monitoring and appropriate actions. The growing array of monitoring devices contributes to this effort by providing increased convenience and accuracy.
LeRoith
Derek
D
Division of Endocrinology and Metabolism, Georgetown University School of Medicine, Washington, DC, USA. leroith@comcast.net
Smith
Deirdre O
DO
D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis* / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation / Q000379:methods; D003920:Diabetes Mellitus / Q000097:blood* / Q000517:prevention & control / Q000628:therapy*; D004867:Equipment Design; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D010353:Patient Education as Topic
D001786:Blood Glucose; D006442:Glycated Hemoglobin